Health Management Systems, Inc. Eligibility Operations Advisor I in Irving, Texas

HMS makes the healthcare system work better for everyone. We fight fraud, waste, and abuse so people have access to healthcare—now and in the future. Using innovative technology and powerful data analytics, we help government and commercial payers reduce costs, increase quality, and achieve regulatory compliance. We also help consumers take a more active role in their own health. Each year, we save our clients billions of dollars while helping people live healthier lives. At HMS, you will develop new skills and build your career in a dynamic industry while making a difference in the lives of others.

We are seeking a talented individual for a Eligibility Operations Advisor I who is responsible for verifying, documenting and coordinating information needed to process applications and other Eligibility Operations assignments. Conducts health insurance policy analysis, documentation verification, employer coordination and customer service while ensuring accurate data entry, validation and timely processing.

Essential Responsibilities: :

  • Provide enrollment assistance and HIPP/Premium Assistance program information over the phone to Medicaid eligible recipients and their family members.

  • Verify, document and investigate the presence of health care coverage for Medicaid recipients and their families.

  • Assist in the identification of members that may qualify for the HIPP/Premium Assistance program.

  • Complete periodic reports.

  • Customer service to include high volume of phone work answering questions and other inquiries regarding the HIPP/Premium Assistance program.

  • Data entry to include accurate and timely entry of information.

  • Obtain and/or verify all items related to eligibility and enrollment into the HIPP/Premium Assistance program.

  • Complete maintenance of active cases during open enrollment and premium review for check processing to assist with maintaining the revenue and program growth.

Non-Essential Responsibilities:

  • Performs other functions as assigned

Knowledge, Skills and Abilities:

  • Ability to organize well.

  • Ability to provide and represent professionalism in job.

  • Ability to practice flexibility and adaptability in the work place.

  • Ability to work with Microsoft Word and Excel and navigate internet skillfully.

  • Ability to analyze information and use logic and process to address work-related issues and problems.

  • Ability to operate with strong interpersonal skills.

  • Ability to be careful and thorough about detail.

  • Ability to perform data entry accurately.

  • Average manual dexterity in use of a PC, phone, 10 key, sorting, filing and other office machines.

  • Ability to handle conflict appropriately and constructively.

  • Working knowledge of HIPAA privacy and Security rules.

  • Ability to perform well in team environment.

  • Ability to meet deadlines.

  • Ability to handle pressure and deadline oriented project demands

Work Conditions and Physical Demands:

  • Primarily sedentary work in a general office environment

  • Ability to communicate and exchange information

  • Ability to comprehend and interpret documents and data

  • Requires occasional standing, walking, lifting, and moving objects (up to 10 lbs.)

  • Requires manual dexterity to use computer, telephone and peripherals

  • May be required to work extended hours for special business needs

  • May be required to travel at least 10% of time based on business needs

Minimum Education:

  • High School Diploma or equivalent required

Minimum Related Work Experience:

  • Min. 2 year of experience in insurance industry, health care or government sponsored health insurance to include customer service and medical billing knowledge or similar math related experience.

  • Min. 2 year experience working on the phone making inquiries (outbound) and answering calls (inbound).

  • Knowledge of health care terminology is a plus.

Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to this job at any time.

Title: Eligibility Operations Advisor I

Location: Texas-Irving

Requisition ID: 1800112F

EEO/Minorities/Females/Protected Veterans/Disabled.