Enrollment Technician - CommonSpirit Health

The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Health’s Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups hospitals health plans and employers with a business objective to excel in coordinating patient care in a manner that supports containing costs while continually improving quality of care and levels of service. Dignity Health MSO accomplishes this by capitalizing on industry-leading technology and integrated administrative systems powered by local human resources that put patient care first.

Dignity Health MSO offers an outstanding Total Rewards package that integrates competitive pay with a state-of-the-art flexible Health & Welfare benefits package. Our cafeteria-style benefit program gives employees the ability to choose the benefits they want from a variety of options including medical dental and vision plans for the employee and their dependents Health Spending Account (HSA) Life Insurance and Long Term Disability. We also offer a 401k retirement plan with a generous employer-match. Other benefits include Paid Time Off and Sick Leave.

***This position is remote with the ideal candidate residing within California, or willing to work PST business hours.

Position Summary:

Coordinate the membership enrollment process for various health plans to ensure information is accurately recorded and entered timely according to department guidelines. Responsible for reconciling membership against capitation payments received from delegated health plans.

Responsibilities may include:
- Processes enrollment/eligibility files for all lines of business.
- Reconciles membership to the capitation payments received from the delegated lines of business.
- Contacts health plans and/or employer groups to resolve questions on member enrollment.
- Verifies Primary Care Physicians and effective dates. Confirms member information including coverage and termination effective dates, member address and plan benefits.
- Responds to general inquiries or questions in the area of eligibility.
- Maintains and processes eligibility files within the database to ensure information is accurate.
- Supports Configuration partners (Contracting and Benefits) with various tasks to ensure department goals are met in a timely manner.

***This position may be filled at a level I, II or III, dependent upon the qualifications of the final candidate. Additional qualifications needed include 5-7+ years of experience and demonstrated experience in handling complex enrollment and eligibility processes, as well as an Associates or Bachelors degree or equivalent experience (3-5 additional years of related job or industry experience).

Minimum Qualifications:

- 3+ years in an administrative role w/ related experience (ie: office admin support, insurance services, customer service, etc.)
- High School Diploma or GED

Preferred Qualifications:

- 3+ years of related experience in the Managed Care/Healthcare Industry preferred.
- Associates or Bachelor's Degree in Business Administration or other related field preferred.
- Certification in Healthcare Administration or Managed Care preferred.
- Advanced Excel skills, including pivot tables, VLOOKUP, and data analysis functions preferred.
- Experience with process improvement methodologies (e.g., Lean, Six Sigma) preferred.

- Health plan experience strongly preferred.

- Experience with insurance eligibility verification strongly preferred.