Rockford Health System
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ENROLLMENT REPEPRESENTATIVE 2
at Rockford Health System
Active Full Time Hourly (80 ppp) FTE 1.0
Work Hours: 8a-5p
Responsible for the membership enrollment area for all lines of business and MercyCare products. Will handle day-to-day member enrollment data entry, maintenance processes and functions using managed care software. Process, maintain and problem resolution of electronic enrollment files. Organizes and maintains materials for customized benefit packages for all insurance products. Responsible for the member identification card process and materials for all products. Responds to all internal and external customer inquiries regarding enrollments and plan documents. To perform this job successfully, an individual should have knowledge of membership and group enrollment processing systems; Spreadsheet software and Word processing software. Able to work with minimal supervision and performs other duties as assigned. Weekly pharmacy enrollment and troubleshoot member discrepancy reports. Membership downloads from secure sites for groups, including monthly file compare and maintenance. Other duties as assigned.
ESSENTIAL DUTIES AND RESPONSIBILITIES
- Creates alternatives and identifies key requirements to assist with process improvements and workflows.
- Problem investigation ranging from moderate to complex situations or data requires detailed review of factors and issues between departments and outside contacts.
- Follow policies and procedures and adapt to changes.
- Demonstrate accuracy and thoroughness and improve and promote performance quality.
- Responds promptly to requests and assistance and maintains confidentiality and respect.
- Skillfully identify and resolve problems in a timely manner.
- Demonstrate persistence and overcome unexpected obstacles.
- Display willingness to make and follow through with decisions.
CULTURE OF EXCELLENCE BEHAVIOR EXPECTATIONS
To perform the job successfully, an individual should demonstrate the following behavior expectations:
Quality - Follows policies and procedures; adapts to and manages changes in the environment; Demonstrates accuracy and thoroughness giving attention to details; Looks for ways to improve and promote quality; Applies feedback to improve performance; Manages time and prioritizes effectively to achieve organizational goals.
Service - Responds promptly to requests for service and assistance; Follows the Mercyhealth Critical Moments of service; Meets commitments; Abides by Mercyhealth confidentiality and security agreement; Shows respect and sensitivity for cultural differences; and effectively communicates information to partners; Thinks system wide regarding processes and functions.
Partnering - Shows commitment to the Mission of Mercyhealth and Culture of Excellence through all words and actions; Exhibits objectivity and openness to other's views; Demonstrates a high level of participation and engagement in day-to-day work; Gives and welcomes feedback; Generates suggestions for improving work: Embraces teamwork, supports and encourages positive change while giving value to individuals.
Cost - Conserves organization resources; Understands fiscal responsibility; Works within approved budget; Develops and implements cost saving measures; contributes to profits and revenue.
EDUCATION & EXPERIENCE
High School Diploma or equivalent. A minimum of 1 to 2 years of experience in enrollment processing in a managed care environment. Prior knowledge of computer spreadsheet and word processing applications preferred.
Passing the Driver’s License Check and/or Credit Check (for those positions requiring).
Passing the WI Caregiver Background Check and/or IL Health Care Workers Background Check.
Must be able to follow written/oral instructions.
OTHER SKILLS AND ABILITIES
Ability to plan and develop work plans, especially during high periods of peak activity. Efficiently prioritize and organize work activities timely including goal setting and objectives. Must be able to perform each essential duty satisfactorily. Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions with common sense understanding furnished in written, oral, diagram or schedule form. Must have excellent written and communication skills, quick-learner, basic math skills and problem solving. Trains and mentors new enrollment staff.
Ability to write routine reports, correspondence and participate in the development of formal policies and procedures. Ability to read, analyze and interpret general business periodicals, technical procedures, or governmental regulations. Ability to effectively present information and respond to questions from groups or managers, clients, customers, and the general public. Speaks clearly and professionally in positive or negative situations; Listens and gets clarification; Participates in meetings.
Excellent telephone and oral communication skills. Excellent, thorough and accurate data entry skills.
The noise level in the work environment is usually quiet.
Occupational Exposure: Category C - No partners in the specified job classification have occupational exposure.
Partner may access patient care information, financial data, human resource data and strategic and planning data needed to perform their job duties as directed by the director.
WORK CONTACT GROUP
Position requires frequent communication with employer group contacts, agents, and members as well as, all levels of Mercy Health System personnel.
SPECIAL PHYSICAL DEMANDS
The Special Physical Demands are considered Essential Job Functions of the position with or without reasonable accommodations.
While performing the duties of this job, the employee is regularly required to walk; use hands to finger, handle, or feel; reach with hands and arms; climb or balance; stoop, kneel, crouch, or crawl. The employee is frequently required to sit and work at a computer for long periods of time up to 10 hours daily. The employee is occasionally required to stand for long periods of time. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus. The employee must be able to hear at high and low levels through voice and telephone communications to be able to respond to patients and partners.
While performing the duties of this job, the employee must have good manual dexterity to operate keyboard and telephone; repetitive finger/wrist movement associated with use of keyboard. Requires exerting 25 to 50 pounds of force occasionally, and lift up to 10 to 15 pounds frequently.
LEVEL OF SUPERVISION
Some independent judgment is required, but alternatives are limited by standard practices or procedures.
Assignments are normally received in the form of results expected and due dates. General procedures are available to guide work. This job has no supervisory responsibilities.