enrollment representative

PrimeWest Health

<div><div><p>Join our team and play a key role in ensuring accurate member enrollment and eligibility!</p>
<div>
<p><b>What You&rsquo;ll Do:</b></p>
<ul><li>
Process enrollment records and update eligibility in the membership system.</li><li>
Review and resolve discrepancy reports from internal teams, DHS, and CMS.</li><li>
Research and troubleshoot eligibility/enrollment issues and coordinate benefit changes.</li><li>
Sort and distribute daily mail for the department.</li><li>
Ensure compliance with departmental policies, procedures, and workflows.</li><li>
Deliver exceptional customer service to internal and external partners.</li><li>
Work primarily on the computer with minimal member contact.</li></ul>
<p><b>
What We&rsquo;re Looking For:</b></p>
<ul><li>
Strong analytical skills and attention to detail.</li><li>
High level of reading comprehension.</li><li>
Proficiency in Microsoft Office, especially Excel.</li><li>
Ability to self-motivate, work independently, and apply critical thinking.</li><li>
Previous experience in bookkeeping, accounting, health insurance, or related fields (preferred).</li><li>
Willingness to learn&mdash;on-the-job training provided!</li></ul>
</div></div><div><ul><li><b>Expert Knowledge</b> &ndash; Familiar with Medical Assistance eligibility, demographics, and privacy rules for member communication.</li><li><b>
Regulatory Awareness</b> &ndash; Understanding of Medical Assistance and Medicare guidelines.</li><li><b>
Organized &amp; Efficient</b> &ndash; Skilled at prioritizing tasks and following set instructions accurately.</li><li><b>
Problem Solver</b> &ndash; Applies resolutions correctly and demonstrates strong analytical skills.</li><li><b>
Team Player &amp; Independent Worker</b> &ndash; Thrives both in collaboration and working solo.</li><li><b>
Clear Communicator</b> &ndash; Able to follow verbal instructions effectively.</li></ul>
<p></p><ul><li><b>Education/Experience</b> &ndash; Diploma in business or health-related field, or 1+ year of relevant experience (Medicare/Medical Assistance knowledge is a plus).</li><li><b>
Tech Proficiency</b> &ndash; Skilled in Microsoft Word, Excel, and Outlook.</li><li><b>
Adaptable &amp; Detail-Oriented</b> &ndash; Handles multiple tasks with strong organizational skills and attention to detail.</li><li><b>
People Skills</b> &ndash; Works well with diverse individuals; excellent verbal and written communication.</li><li><b>
Physical Requirements</b> &ndash; Comfortable at a desk/computer station; able to lift up to 25 lbs occasionally.</li></ul><br>
<p></p>
<ul><li><b>
Position is in the office M-F 8:00 a.m. to 4:30 p.m. at 3905 Dakota Street, Alexandria, MN</b></li></ul>
</div><div>
<p><b>Why You&rsquo;ll Love Working Here:</b></p>
<ul><li><b>
Comprehensive Benefits</b> &ndash; Medical, dental, and vision coverage.</li><li><b>
Generous Paid Time Off </b>&ndash; Vacation, sick, holidays, and personal days.</li><li><b>
Pension</b>-Public Employee Retirement Association (PERA)</li><li><b>
Professional Growth</b> &ndash; On-the-job training and development opportunities.</li><li><b>
Work-Life Balance</b> &ndash; Regular business hours and a positive team culture.</li></ul><br>
<p></p>
<p><b>
Ready to make an impact?</b><br>
As an <b>Enrollment Data Specialist</b>, you&rsquo;ll play a vital role in ensuring accurate member enrollment and eligibility while working in a collaborative, supportive environment. This position offers the perfect blend of independence and teamwork, with opportunities to grow your skills and contribute to a mission-driven organization.</p>
<p>
Join us and be part of a team that values accuracy, problem-solving, and innovation.</p>
<p><b>
Apply today and start your journey with us!</b></p></div></div>

Enrollment Data Specialist

Lutheran SeniorLife

<div>Overview:
<div>
Enrollment Manager</div><div></div><div><br>
LIFE Armstrong<br>
Located in Kitanning, PA, Lawrence County</div><div></div><div><br>
Full-time 8:30 a.m. to 5:00 p.m.</div><div></div><div><br>
Lutheran SeniorLife provides a comprehensive array of community-based health and social service programs throughout western Pennsylvania.</div><div>
Our services include LIFE (Living Independence for the Elderly); skilled nursing, home health; personal care; adoption &amp; foster care; assisted living; adult day services; memory care; hospice; palliative care; residential living; affordable housing; home safety monitoring; Meals on Wheels; rehabilitation services and private duty.</div><div></div><div><br>
LIFE is a program that serves county residents living in Armstrong, Butler, Beaver and Lawrence Counties. It is an all-inclusive comprehensive program that helps individuals maintain their independence in their home and community through supportive services. The LIFE programs offer an array of person-centered services from medical care to adult day supports with the primary goal of allowing individuals to remain in their own home.</div><div></div><div><br>
The Enrollment Manager is a confidential position that oversees and manages the assigned Enrollment Department, which includes the supervision of the Intake Coordinator(s). This position is responsible for ensuring all enrollment processes are occurring in a timely manner and in accordance with regulatory requirements. A major component of this position is managing and meeting growth and operating targets.</div>
Qualifications:
<div>
Enrollment Manager qualifications include:</div><br>
<div></div><ul><li>
1-2 years supervisory experience and/or equivalent education and training related to health care management.</li><li>
At least one year experience with a frail or elderly population.</li><li>
Working knowledge of computers, Microsoft Word and Excel required.</li></ul><div><b>
Benefits</b></div><div></div><div><br>
Lutheran SeniorLife offers a variety of benefits to employees and their families, as applicable, including but not limited to:<br>
*based on employment status*</div><br>
<div></div><ul><li>
Competitive Wages, Hiring Incentives, Generous Paid Time Off, Bereavement Leave &amp; Paid Holidays</li><li>
Individual Coverage Health Reimbursement Arrangement (ICHRA) health benefits solution. ICHRA provides larger flexibility and customization in medical plan options while still providing the tax benefits of a group plan.</li><li>
Dental, Vision, Life Insurance, and Long-Term Disability plans.</li><li>
Voluntary Suite of Benefits Available at Low Group Rates, including Short-Term Disability, Critical Illness, Hospital Indemnity, Accident Insurance, Identity Theft Protection, Legal Services, Pet Insurance, and Additional Life Insurance Options</li><li>
Employer-sponsored child care benefits.</li><li>
Immediate eligibility to participate in the employer-sponsored retirement savings plan</li><li>
FSA availability, depending on the individual health plan selected</li><li>
Total Wellness and WorkLife Balance resources, discounts, programs</li><li>
Tuition Reimbursement and Mileage Reimbursement for Eligible Employees</li><li>
Career Success - coaching, training, internships and recognition program</li></ul><div><b>
Lutheran SeniorLife and its affiliates are equal opportunity employers.</b></div><br>
<div></div>
Shift: Daylight Typical Work Hours: 8:30 a.m. to 5:00 p.m.</div>

Enrollment Manager

Temporary Professional Integrated Services

<div><div><div><div><p>Analyzing and determining the prospect eligible for the Medicare Advantage Programs.</p><p><b>
Responsabilities:</b></p><ul><li>
Receives and processes applications for Enrollment, unsubscribe, Cancellation, and Product Changes received in the Eligibility Unit within 7 days.</li><li>
Evaluates, analyze, and determines that enrollment documents submitted by Sales Representatives and Independent Agents comply with established state, federal, and business regulations.</li><li>
Determines prospect eligibility in CMS and Ases systems, performs data entry or correction in Voyager and On Base systems, determines applicable eligibility period, makes notes, and sends appropriate letters.</li><li>
Identifies cases that cannot be processed due to missing information, which initiates the returns process. This process includes documentation in the system of the reason for return, notification by letter to the prospect, and internal notification to the sales areas.</li><li>
Generates weekly reports of all cases in the system awaiting information, ensuring final determination does not exceed the applicable 7 or 21 days, to comply with current federal regulations.</li><li>
Works the weekly audit report to ensure that no case has been processed or denied without a notification letter. All required letters must be sent within 7-10 days.</li><li>
Complies with the OFA (Out of Area) unsubscribe process, which should be done within the first 3 days of each month. If receives an OFA unsubscribe cancellation request, analyzes, and evaluates if the case meets the necessary criteria to submit the request and generates the applicable letter within 7 days.</li><li>
Monitors analyzes, and documents cases under the LEP (Late Enrollment Penalty) process in the Lep Track and Voyager applications daily.</li><li>
Analyzes cases referred by the Grievance and Appeals Unit related to enrollment and unsubscribe processes. Provides requested information and offers recommendations for action within 24-48 hours.</li><li>
Responsible for receiving, punching, classifying, and digitizing all internal and external correspondence received in the Affiliations Unit.</li><li>
Must comply fully and consistently with all company policies and procedures, with local and federal laws as well as with the regulations applicable to our Industry, to maintain appropriate business and employment practices.</li></ul><p><b>
Requirements:</b></p><ul><li><b>
Education and experience: </b>60 university credits or equivalent to two (2) years of studies or associate degree in Business Administration or Health Services Billing preferably. Minimum of one (1) year of experience in group and individual enrollment processes, preferably in the Health Insurance Industry.</li></ul><p>
Monday to Friday</p><p>
8am-5pm</p></div></div><div><p>
Job Type: Full-time</p></div><div><p>
Salary: $13.00 per hour</p></div><div><p>
Physical setting:</p><ul><li>
Office</li></ul><p>
Schedule:</p><ul><li>
8 hour shift</li><li>
Monday to Friday</li></ul></div></div></div>

PR-ENROLLMENT AND ELIGIBILITY ANALYST

ApplyBoard

<div><div>ApplyBoard simplifies the study abroad search, application, and acceptance process by connecting international students, recruitment partners, and educational institutions on one intuitive and personalized platform. ApplyBoard is a mission-driven, hyper-growth organization. It has been attracting dedicated individuals for more than eight years who are inspired every day to break down barriers to international education and take their careers to new heights at a company that will invest in their career growth. Our <div>six core values</div> are our compass in our mission to Educate the World and the foundation of our unique company culture. As an organization built on a foundation of diversity, it&rsquo;s important that our team members are representative of the students from more than 150 countries that we support.</div><div></div><div>
The Opportunity:</div><div></div><div>
A partner-facing account and sales representative responsible for day-to-day management of differentiated institution partners. This role works closely with both internal recruitment teams and the institution to drive targeted enrollment growth. The dedicated Representative ensures the execution of institutional priorities, recruitment alignment, and conversion strategies, acting as the main liaison for admissions-related support and growth enablement.</div><div></div><div>
What you&rsquo;ll be doing every day:</div><ul><li><div>
Execute Recruitment Strategies: Implement and optimize recruitment strategies to meet and exceed enrollment goals for differentiated partners.</div></li><li><div>
Increase Conversion Rates: Enhance conversion rates by using tailored RP (Recruitment Partner) activation, training, and strategic alignment with institutional priorities</div></li><li><div>
Service Adoption: Ensure the adoption of premium and differentiated services and integrations to maximize partner satisfaction and outcomes.</div></li><li><div>
Customization of Engagement: Develop and customize engagement and reporting models that align with the unique goals of each institution partner.</div></li><li><div>
Liaison Role: Serve as the main point of contact between institutional stakeholders and internal ApplyBoard teams, ensuring clear communication and collaboration.</div></li><li><div>
Cross-Functional Collaboration: Work with various cross-functional teams to address partner-specific priorities, troubleshoot issues, and remove any operational bottlenecks.</div></li><li><div>
CRM Management: Maintain up-to-date records in CRM and documentation systems with partner-specific activities, preferences, and performance data on a daily basis.</div></li><li><div>
Relationship Management: Conduct monthly syncs with the institution's international recruitment and admissions teams to foster strong relationships and align strategies.</div></li><li><div>
Workshops and Training: Facilitate monthly conversion workshops and training sessions or enrollment enablement tactics for top recruitment partners.</div></li><li><div>
Issue Resolution: Partner with the Customer Experience team to coordinate the resolution of admissions and operational issues impacting conversion rates on an ongoing basis.</div></li></ul><div></div><div>
What you bring to the table:</div><ul><li><div>
 2-3 years of experience in account management, sales, or recruitment, preferably in the education sector.</div></li><li><div>
Bachelor's degree in Business, Marketing, Education, or a related field preferred</div></li><li><div>
Strong understanding of enrollment processes and strategies within differentiated institutions.</div></li><li><div>
Excellent communication and interpersonal skills to build rapport with internal and external stakeholders.</div></li><li><div>
Proficient in CRM software and data analysis tools.</div></li><li><div>
Ability to work collaboratively in a team environment and adapt to changing priorities.</div></li><li><div>
Strong problem-solving skills and attention to detail</div></li></ul><div></div><div>
About ApplyBoard</div><div></div><div>
ApplyBoard empowers students around the world to access the best education. With more than 1,000,000 students from over 150 countries helped with their journey in less than a decade, we are just getting started.</div><div></div><div>
ApplyBoard&rsquo;s global team assists students and our 1,500+ partner institutions by empowering the international student sector with innovative technology and insights. As a five-time consecutive Deloitte Fast 50 and Fast 500 ranked company, ApplyBoard keeps international students at the heart of everything we do.</div><div></div><div>
Thank you for your interest in joining the ApplyBoard Team and being part of our mission to Educate the World. While we are lucky to attract a high level of interest in each of our roles, only qualified applicants will be contacted and selected for an interview.</div><div></div><div>
ApplyBoard welcomes and encourages applications from people with disabilities. Accommodations are available upon request for candidates in all aspects of the hiring and selection process.</div></div>

Enterprise Recruitment Manager

CVS Health

<div><p>At CVS Health, we&rsquo;re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.</p><p></p><p>
As the nation&rsquo;s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues &ndash; caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.</p><p></p><p><b>
Business Overview</b></p><p>
As part of the bold vision to deliver the &ldquo;Next Generation&rdquo; of managed care in Ohio Medicaid, OhioRISE will help struggling children and their families by focusing on the individual, with strong coordination and partnership among MCOs (<i>Managed Care Organizations</i>), vendors, and ODM (<i>Ohio Department of Medicaid</i>) to support specialization in addressing critical needs. The OhioRISE Program is designed to provide comprehensive and highly coordinated behavioral health services for children with serious/complex behavioral health needs involved in, or at risk for involvement in, multiple child-serving systems.</p><p></p><p><b>
Position Summary</b></p><p>
The <b>Eligibility and Operations Specialist</b> plays a key role in managing and reconciling OhioRISE eligibility and CME (<i>Care Management Entity</i>) enrollment issues. The <b>Eligibility and Operations Specialist</b> will provide support on a wide range of complex enrollment activities. This person is responsible for ensuring prompt and accurate enrollment information achieved through daily enrollment report reviews.</p><p></p><p>
This person reports to the Chief Operating Officer and works in close partnership with the Director of the CME Alliance Hub, as well as all matrixed growth partners, to effectively support our CME partners, as well as the youth and families in their care.</p><p></p><p><b>
Responsibilities include:</b></p><ul><li>
Reconcile ODM eligibility files with CME membership files to ensure the accuracy of CME assignments.</li><li>
Daily review of enrollment reports to research and resolve errors in eligibility coverage breaks, correct duplicate member ID numbers, and monitor retro Medicaid reinstatements for downstream impact on claims.</li><li>
Serve as health plan representative for enrollment revenue reconciliation meetings.</li><li>
Oversee enrollment reporting and ad hoc requests.</li><li>
Use databases and Microsoft Excel to identify and analyze trends in data.</li><li>
Identify manual processes for automation opportunities.</li><li>
Review error reports and process file fallouts.</li><li>
Oversee various updates of workflows and policy &amp; procedures.</li><li>
Provide thorough, timely, and accurate resolution of reconciliation disputes and escalated complex cases via telephone, email, and other methods.</li><li>
Accurately research and resolve data discrepancies to ensure data integrity across external partners.</li><li>
Other duties as assigned.</li></ul><p></p><p><b>
Required Qualifications</b></p><ul><li>
3-5 years of experience with Medicaid and/or managed care operations and/or enrollment processes.</li><li>
Must reside in Ohio.</li><li>
Demonstrated proficiency with personal computer, keyboard navigation skills and with Microsoft Office Suite applications (Outlook, Word, Excel, PowerPoint, SharePoint, etc.)</li></ul><p></p><p><b>
Preferred Qualifications</b></p><ul><li>
Demonstrated relationship management skills; capacity to quickly build and maintain credible relationships at varying levels (externally and within the organization).</li><li>
Strong organization skills, creativity, and member-focused approach.</li><li>
Excellent communication skills.</li><li>
Adept at interdepartmental collaboration.</li><li>
Associate&rsquo;s or Bachelor&rsquo;s degree.</li></ul><p><b><br>
Education</b></p><ul><li>
High school diploma or GED.</li></ul><p></p><p><b>
Anticipated Weekly Hours</b></p>
40<p></p><p><b>
Time Type</b></p>
Full time<p></p><p><b>
Pay Range</b></p><p>
The typical pay range for this role is:</p><p></p>
$21.10 - $36.78<p></p><p>
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.</p><p><br>
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.</p><p></p><p><b>
Great benefits for great people</b></p><p></p><p>
We take pride in our comprehensive and competitive mix of pay and benefits &ndash; investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:</p><ul><li><p><b>
Affordable medical plan options,</b> a <b>401(k) plan </b>(including matching company contributions), and an <b>employee stock purchase plan</b>.</p></li><li><p><b>
No-cost programs for all colleagues </b>including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</p></li><li><p><b>
Benefit solutions that address the different needs and preferences of our colleagues</b> including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.</p></li></ul><p></p><p>
For more information, visit https://jobs.cvshealth.com/us/en/benefits</p><p></p>
We anticipate the application window for this opening will close on: 01/13/2026<p></p><p>
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.</p></div>

Eligibility and Operations Specialist (OhioRISE)

Behavioral Health Group

<p></p><div><p><b>Remote Position - Requires Payor Credentialing and Payor Enrollment experience</b></p>
<p>
The Payor Credentialing Specialist is responsible for leading, coordinating, monitoring, and maintaining the payor and provider credentialing and re-credentialing processes. Facilitates all aspects of BHG&rsquo;s payor credentialing including payor enrollments, revalidations, maintenance, license updates, and follow up on payor credentialing related A/R issues. Ensures interpretation and compliance with the appropriate accrediting and regulatory agencies, while developing and maintaining a working knowledge of the statues and laws relating to payor credentialing and enrollment. Responsible for the accuracy and integrity of the credentialing database system and related applications. Works under the supervision of the Director of Payor Credentialing in conjunction with Chief Revenue Officer.</p>
<p>
The key responsibilities of the Payor Credentialing Specialist include but not limited to:</p>
<p><b>
Duties and Responsibilities</b></p>
<ul>
<li>Prompt and regular attendance at an assigned work location.</li>
<li>Ability to complete or oversee the completion of assigned tasks/projects in a timely manner.</li>
<li>Complete process to enroll and credential facilities as well as providers with insurances; ensure all payor criteria are met.</li>
<li>Leads, coordinates, and monitors the collection, review, and analysis of payor enrollment applications.</li>
<li>Responsible for accuracy and completeness of payor enrollment submissions including supporting documentation.</li>
<li>Follow up with providers and insurances for timely credentialing and enrollment process(es).</li>
<li>Responsible for monitoring application progress and following up with payors as needed until confirmation of credentialing and network load is complete.</li>
<li>Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow-up.</li>
<li>Review, and update if necessary; health plan directories, agencies, and other appropriate entities for current and accurate provider information</li>
<li>Responds to inquiries from other healthcare organizations, interfaces with internal and external customers on day-to-day credentialing and enrollment issues as they arise.</li>
<li>Utilizes the credentialing database, optimizing efficiency, and performs query, report and document generation.</li>
<li>Enters and maintains accuracy of data input into Credential Stream, PECOS, NPPES, CAQH, Optum, Availity, and other payor portals.</li>
<li>Verify provider accuracy in payor directories.</li>
<li>Provide support with managed care delegated credentialing audits; conduct internal file audits.</li>
</ul>
<p><b>Regulatory</b></p>
<ul>
<li>Ensure compliance with regulatory bodies (Joint Commission, NCQA, URAC, CMS, federal and state laws) and policies and procedures in all aspects of the payor credentialing process.</li>
</ul>
<p><b>Marketing and Outreach</b></p>
<ul>
<li>Participate in community and public relations activities as assigned.</li>
</ul>
<p><b>Professional Development</b></p>
<ul>
<li>Demonstrates the belief that addiction is a brain disease, not a moral failing.</li>
<li>Demonstrates hope, respect, and caring in all interactions with patients and fellow team members.</li>
<li>Establishes and maintains positive, professional relationships in the workplace.</li>
<li>Ability to work independently and under deadlines while handling multiple tasks simultaneously.</li>
<li>Makes decisions and uses good judgment with confidential and sensitive issues.</li>
<li>Maintain professional, calm demeanor with others in stressful or other undesirable situations.</li>
</ul>
<p><b>Training</b></p>
<ul>
<li>Attend and complete all required trainings as assigned by Director.</li>
<li>Prompt and regular attendance at an assigned work location.</li></ul><br>
<p></p>
<p><b>
Minimum Requirements
</b></p><ul><li>The Credentialing Administrator needs at least 3 to 5 years of experience in payor credentialing/enrollment experience.</li>
</ul>
<p><b>Qualifications</b></p>
<ul>
<li>Bachelor&rsquo;s degree preferred or comparable work experience.</li>
<li>Current CPCS or CPMSM certification or working towards certifications.</li>
<li>Experience or working knowledge of full credentialing cycles; initial payor credentialing/enrollment, maintenance and revalidation.</li>
<li>Experience or working knowledge of CredentialStream credentialing platform or other credentialing database software.</li>
<li>Excellent attention to detail, problem-solving, critical thinking, and analytical skills.</li>
<li>Strong working knowledge of word processing, spreadsheets, data entry, database experience and other computer related skills.</li></ul><br>
<p></p>
<p>
In addition to meeting the qualifications, the ideal candidate will embody the following characteristics and possess the knowledge, skills and abilities listed below:</p>
<ul>
<li>Holds a basic understanding of substance use disorder.</li>
<li>The highest ethical and professional standards.</li>
<li>Maintains the strictest confidentiality.</li>
<li>Excellent written and verbal communication skills.</li>
<li>Excellent attention to detail and problem-solving skills required.</li>
<li>Excellent analytical, judgment, and decision-making skills.</li>
<li>Proficient in Adobe, Excel, PowerPoint, Word, Outlook, and other Microsoft Office applications.</li>
<li>Well organized, capable of juggling multiple projects and accustomed to tight deadlines.</li>
<li>Ability to work effectively and independently with both clinical and non-clinical colleagues.</li>
<li>Ability to perform research independently.</li></ul><br>
<p></p>
<p><b>
Physical Requirements and Working Conditions
</b></p><p>The physical demands described here are representative of the requirements that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions to the extent such accommodation does not create an undue hardship on the business.</p>
<ul>
<li>Speaking and hearing ability sufficient to communicate effectively by phone or in person at normal volumes</li>
<li>Vision adequate to read correspondence, computer screen, forms, etc.</li>
<li>Sit for long periods of time, some bending, stooping and stretching</li>
<li>Variable workload, periodic high activity level</li>
<li>Keyboarding for long periods of time</li></ul><br>
<p></p>
<p><b><i>
Disclaimer
</i></b></p><p><i>The above statements are intended to describe the general nature and level of work being performed by team members assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of team members so classified. All team members may be required to perform duties outside of their normal responsibilities from time to time, as needed, and this job description may be updated at any time.</i></p>
<p><i>
BHG is an equal opportunity, affirmative action employer providing equal employment opportunities to applicants and employees without regard to race, color, religion, age, sex, sexual orientation, gender identity/expression, national origin, protected veteran status, disability status, or any other legally protected basis, in accordance with applicable law.</i></p><p></p><p>
Equal Opportunity Employer<br>
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.</p></div>

Payor Credentialing Specialist (remote)

Cantex Continuing Care Network

<div><p><b>Job Summary:
</b></p><p></p><p>The Benefits Specialist is responsible for overseeing the daily administration of employee benefit records including eligibility, elections life events and premium deductions through on-line enrollment software and payroll records. Also responsible for the reconciliation and processing of benefit plan invoices.
</p><p><b>Qualifications:</b></p><p>
</p><ul><li>2+ years experience in Benefits
</li><li>Must have experience with reconciling benefit plan invoices</li><li>
Working knowledge of current benefits laws and regulations and ensures compliance with applicable ACA, HIPAA, DOL, ERISA and IRS.</li><li>
High level of customer service skills in order to build productive relationships with employees at all levels as well as outside vendors</li><li>
Working knowledge of FMLA and disability plans</li><li>
Proficiency in HRIS, Benefits software and Microsoft Office suites.</li><li>
Detail oriented with exemplary organizational and time management skills</li><li>
Proven ability to maintain confidentiality and discretion when handling sensitive and proprietary information</li><li>
Ability to work independently or in a team environment</li><li>
Ability to manage projects and meet deadlines</li></ul><p>
</p><h1 class="jobSectionHeader"><b>Essential Functions:</b></h1><p>
</p><ul><li>Ensure timely communication of benefits eligibility to affected employees to meet ACA requirements and notifications.</li><li>
Administration of benefit plans including enrollment of new hires, monitoring life event changes and employment status changes resulting in eligibility changes.</li><li>
Assists with managing annual open enrollment, including reconciliation of employee enrollments.</li><li>
Reconcile and process benefit plan invoices, reports and other communications to outside provides; coordinates timely and accurate payment for all benefit programs.</li><li>
Coordinates with Payroll Specialist in ensuring all premium deductions are set up accurately and timely.</li><li>
Process all employer responses for disability and life claims</li><li>
Administration of FMLA and the collection of insurance premiums during a leave of absence.</li><li>
Ensures compliance with applicable federal and state laws and policies and procedures including HIPAA, DOL, ERISA and IRS.</li><li>
Evaluates and enhances internal processes to reduce costs and increase efficiency.</li><li>
Provides technical support and works with end users as well as troubleshoots system problems.</li><li>
Manages interface files to and from vendors to ensure accuracy of employee benefit records and data integrity. Researches and corrects discrepancy files.
</li><li>Builds productive relationships with employees on all levels as well as outside vendors.</li><li>
Compile and report EEOC annual requirements</li><li>
Prepares special reports and records.</li><li>
Acts as liaison between all health plan providers and employees.</li></ul><p>
</p><p><b>Continuing Education:</b></p><p>
</p><ul><li>Attends continuing education programs as necessary.</li></ul><p>
</p><p><b>Physical Demands:</b></p><p>
</p><ul><li>Ability to communicate in English via phone, in writing and verbally in conversation with different levels of staff, Resident families and any outside customers.</li><li>
The physical demands described are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.</li><li>
While performing the duties of this job, the employee is frequently required to stand and walk. The employee is occasionally required to sit, use hands or fingers, handle, or feel; reach with hands and arms, talk or hear and taste or smell. The employee must occasionally lift and/or move up to 50 pounds. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception, and ability to adjust focus. Ability to utilize a computer, phone, etc. for extended periods of time.</li></ul></div><p></p>

Benefits Specialist PRN

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