Qureos Mentor

Partners Behavioral Health Management

<div><div><b><i>Competitive Compensation &amp; Benefits Package!</i></b><p>
Position eligible for &ndash;</p><ul><li>
Annual incentive bonus plan</li><li>
Medical, dental, and vision insurance with low deductible/low cost health plan</li><li>
Generous vacation and sick time accrual</li><li>
12 paid holidays</li><li>
State Retirement (pension plan)</li><li>
401(k) Plan with employer match</li><li>
Company paid life and disability insurance</li><li>
Wellness Programs</li><li>
Public Service Loan Forgiveness Qualifying Employer</li></ul><p>
See attachment for additional details.</p><p></p><p><b><br>
Office Location:</b> Remote position; Available for any of Partners NC locations</p><p><b>
Projected Hiring Range</b>: Depending on Experience</p><p><b>
Closing Date:</b> <b>Open Until Filled</b></p><div></div><div><b><br>
Primary Purpose of Position:</b> The employee provides oversight of the agency Eligibility and Enrollment function and ensures that applicable processes are efficient. Uses reports to monitor workflow efficiency and ensure adherence to applicable policies and procedures. Serves as the eligibility and enrollment liaison between MCO staff, members, and providers.<b><br>
</b></div><div></div><br>
<div><p><b>Role and Responsibilities:</b></p><ul><li>
Provides oversight of the Eligibility and Enrollment Department</li><li>
Assists with creating applicable work reports</li><li>
Prioritizes and assigns work to ensure efficient use of resources</li><li>
Reviews system reports to ensure compliance with Eligibility and Enrollment policies and procedures</li><li>
Notifies appropriate UM staff regarding changes in third party coverage</li><li>
Monitors data entry related to member enrollment including; proof of income, proof of residency, proof of medical insurance availability, and identification documents</li><li>
Provides functional guidance to the Access to Care Processing Assistants</li><li>
Updates account activity and uncovered third party information immediately and accurately</li><li>
Performs account follow up for positive outcomes by communicating verbally and in writing with both internal and external agencies, such as Access to Care, Utilization Management the Social Security Administration, Social Service Departments, clinical homes, etc.</li><li>
Resolves all incoming correspondence pertaining to follow-up on eligibility determination and documentation needed to verify eligibility</li><li>
Analyzes accounts to determine appropriate action to be taken for resolution.</li><li>
Monitors phone call and emails for auditing purposes</li><li>
Conducts all work in a professional and compassionate manner</li><li>
Provides supervision for the Processing Assistants and completes performance appraisals.</li><li>
Performs other related duties as assigned</li></ul></div><p></p><div><div><div><p><b><br>
Knowledge, Skills and Abilities:</b></p><ul><li>
Working knowledge of eligibility requirements for both covered and non-covered Medicaid plans as well as State eligibility criteria, referral processes, and local program requirements for services</li><li>
Knowledge of NC Tracks system</li><li>
Knowledge of community resources and financial resources available for health/medical services to the public</li><li>
General knowledge of mental health, substance use, and intellectual and developmental disability diagnoses</li><li>
Excellent Access to Care skills including the ability to independently work with people with courtesy and tact in performing public contact duties that may be sensitive in nature</li><li>
Excellent computer skills including proficiency in Microsoft Office products</li><li>
Ability to record, compile, summarize and perform basic analysis of data</li><li>
Ability to manage and uphold integrity and confidentiality of sensitive data</li></ul></div><div></div><div><div><div><p><b><br>
Education and Experience Required: </b>Associate Degree in Business, Accounting or Human Services with three years of practical bookkeeping, billing, electronic medical collection techniques or related experience which includes one year experience in Medicaid eligibility or an equivalent combination of training and experience. Must have two (2) years of supervisory experience.</p><p></p><p><b><br>
Education and Experience Preferred:</b> 3 years of supervisory experience preferred.</p></div></div></div></div></div></div></div><p></p>

Eligibility & Enrollment Supervisor (Remote Option, NC)

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Partners Behavioral Health Management

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Eligibility & Enrollment Supervisor (Remote Option, NC)