Enrollment Operations Coordinator (Health Plans)

Samaritan Health Plans (
SHP
) operates a portfolio of health plan products under several different legal structures: InterCommunity Health Plans, Inc. (
IHN
) is designated as a regional Coordinated Care Organization (
CCO
) for Medicaid beneficiaries; Samaritan Health Plans, Inc. offers Medicare Advantage and Commercial Large Group plans. As part of an Integrated Delivery System, Samaritan Health Plans is strategically and operationally aligned with Samaritan Health Services’ mission of Building Healthier Communities Together. As part of an Integrated Delivery System, Samaritan Health Plans is strategically and operationally aligned with Samaritan Health Services’ mission of Building Healthier Communities Together. This is a remote position in which we are able to employ in the following states: Arizona, Arkansas, Connecticut, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Oregon, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, or Wisconsin This position will have some of the following duties and responsibilities: Health plan enrollment and disenrollment processing Member eligibility determination and maintenance Benefit plan setup, configuration, and validation Effective date management and retroactive eligibility corrections Coordination of new member onboarding and coverage changes Understanding of health plan products (commercial, Medicare Advantage, Medicaid, Compliance with
CMS
, state
DOI
,
HIPAA
,
ACA
, and health plan policies Section 111,
MSP
, and coordination of benefits awareness Audit support and regulatory documentation readiness
JOB SUMMARY
/
PURPOSE P
artners and Collaborates with operations staff to ensure that benefits and programs are administered in accordance with regulatory, statutory and plan specific guidelines. Partners with other functional areas to ensure scope specific regulatory compliance and ongoing monitoring reach goals of the plan. Reports audit results to management, finding gaps in operational polices and processes, and develops process improvement for those areas. Manages operational functions such as process improvement, gap analysis, operational discovery, and implementation projects, and coordinates with external vendors, internal staff and committees when necessary to create, review and amend policies, procedures, processes, projects and programs.
EXPERIENCE
/
EDUCATION
/
QUALIFICATIONS B
achelor's degree in a related field or equivalent experience required. Experience and/or training developing professional written correspondence required. Experience and/or training utilizing Microsoft Office products to collect, analyze, and display statistical reports and maintain electronic records required. Project coordination experience preferred. Experience in a health plan leadership role preferred. Experience working with the Oregon Health Plan preferred. Experience and/or training with medical terminology preferred.
KNOWLEDGE
/
SKILLS
/
ABILITIES E
ffective written and verbal communication skills to perform group presentations, tactfully discuss issues, and listen to and understand concepts, rules and procedures. Ability to work with all levels within the organization, facilitate communication, and effectively document related activities. Ability to identify complex problems, review related information, employ creativity and alternative thinking to develop and evaluate options and implement solutions.
PHYSICAL DEMANDS R
arely (1 - 10% of the time) Occasionally (11 - 33% of the time) Frequently (34 - 66% of the time) Continually (67 – 100% of the time)
CLIMB
-
STAIRS LIFT
(Floor to Waist: 0"-36") 0 - 20 Lbs
LIFT
(Knee to chest: 24"-54") 0 – 20 Lbs
LIFT
(Waist to Eye: up to 54") 0 - 20 Lbs
CARRY
1-handed, 0 - 20 pounds
BEND FORWARD
at waist
KNEEL
(on knees)
STAND WALK
–
LEVEL SURFACE ROTATE TRUNK S
tanding
REACH
- Upward
PUSH
(0 - 20 pounds force)
PULL
(0 - 20 pounds force)
SIT CARRY
2-handed, 0 - 20 pounds
ROTATE TRUNK S
itting
REACH
- Forward
MANUAL DEXTERITY H
ands/wrists
FINGER DEXTERITY PINCH F
ingers
GRASP H
and/Fist