BENEFITS | Human Resources

HUMAN RESOURCES BENEFITS COORDINATOR is needed for a large healthcare organization in north Sacramento. This is a full time/40hour, hybrid position. A minimum of one year experience in benefits is required for this role. This position is a stepping stone for endless possibilities working on a team with lots of experience. Opportunity for a career role. Contact RCS at

Overview

Prepares, processes, uploads, and maintains new member or group registration information in the enrollment database.

Responds to member or group eligibility questions, including verifying enrollment status.

Reconciling eligibility discrepancies, analyzing transactional data, and submitting retroactive eligibility changes.

Generates various types of correspondence. Maintains inventory control of member and group transactions.

Responsibilities

• Enters, scans, or updates database information for new enrollments and terminations of group, individual, and ancillary health insurance products.

• Processes demographic changes to member records and primary care provider (PCP) changes, etc.

• Handles enrollment or eligibility inquiries.

• Enters, scans, or updates database information for new enrollments and terminations of various policies.

• Processes demographic changes to member records.

• Handles enrollment or eligibility inquiries from other departments. Responds to all correspondence.

• Reviews all pending enrollments data for accuracy, analyzes any discrepancies, obtains correct information, and reconciles records.

• Identifies performance gaps, recommends, and implements approved improvements to processes.

• Communicates with stakeholders for missing information.

• Reviews enrollment/eligibility submissions to identify unclear, missing, or validate data, investigates discrepancies.

• Submits and reviews test or new eligibility electronic files to ensure format accuracy

• Loads information accurately. Enters and updates information.

• Microsoft Access, Excel, structure query language (SQL) server).

Requirements

• Knowledge of health care operations and structure, basic requirements in integrated delivery system, and use of information system applications in a health insurance or health care environment.

• Working knowledge of health insurance concepts related to enrollment and eligibility practices.

• Basic familiarity with and understanding of Ca Dept of Managed Health Care (DMHC) regulations, health care reimbursement models, pricing mechanisms, managed care and payer relationships.

• Familiarity with relevant file layouts (e.g., Flexible Spending Accounts (FSA), spreadsheet solutions, etc.) for enrollment system uploads.

Pay Range: $23.50 per hour

Must be able to clear a thorough drug screening and criminal background check, provide a minimum of two supervisory references and proper documentation to verify eligibility to work in the USA.

Other compliance factors may be involved, depending on position. River City Staffing is an Equal Opportunity Employer. Job Requirements