• Monitor the daily 834 eligibility file to ensure all members are loaded in the HealthRules system. Thorough investigate any issues with the enrollment file.• Maintain and Prioritize workload ensuring department standard are attained.• Must provide thorough and detail documentation of inquiries and resolution coordinates with other team members and departments to obtain a solution for the member.• Performs daily enrollment tasks related to Medicaid managed care procedures as related to new enrollment, newborns, demographic data changes, primary care provider selection and change requests, cancellation and invalidation.• Sensitivity to confidential information and adherence to HIPAA regulations.• Handle all calls courteously, polite and in a professionally manner.• Prepares source data for entry by opening and sorting mail; verifying and logging receipt of data; obtaining missing data.• Investigates potential COB cases and updates Members record in HealthRules with current information • Protects organization's value by keeping information confidential.• Achieves system objectives by gathering pertinent data; identifying and evaluating options; recommending a course of action.• Other duties as assigned

HealthCare, Call Center Customer Service, Insurance and Marketing

Managed and developed Enrollment Coordinators enabling them to maintain JHHC membership of 221,000 members.• Oversaw the data maintenance and eligibility reconciliation functions of daily 834 file received from the Department of Health and Mental Hygiene (DHMH). • Supported the Priority Partners Enrollment department with attaining credentialing from Delmarva, NCQA, and HEDIS.• Represented the Priority Partners Enrollment department at quarterly Steering Committee meeting with the Department of Health and Mental Hygiene (DHMH) and other MCO’s.• Identified problems and recommend improvement by working with the Department of Decision Support (DDS) to update daily systems allowing the Enrollment department the ability to work efficiently.• Served as a point of contact for providers/members who have questions relating to Medicaid eligibility.

Managed and developed Customer Service Representatives, enabling them to respond to customer needs within company expectations.• Developed procedures by networking with other departments, exhibit exceptional teamwork by collaborating with team members, and possess a strong ability to multi-task. • Supervised, train and audit up to 24 staff members in resolving customer complaints or question about JOHNS HOPKINS HEALTHCARE benefits for EHP, Priority Partners, Kaiser and USFHP.• Monitored and coach staff by using motivational rewards that inspires them to meet company expectations for productivity and to provide quality service to the customer.• Prepared phone reports using (Avaya) that calculated productivity by detailing average speed of answer (ASA), call volume and max delay to influence individual and departmental performance.• Conducted annual performance reviews for team members.

Maintained the daily production and quality, giving guidance and instruction on a daily basis to other representatives on all lines of business. Verify and confirm member information for EHP, BMS, Kaiser Select, and Priority Partners.• Knowledge of HMO, POS., and TPA medical insurance.• Familiar with ICD-9, CPT, HCPC codes, and some Medical terminology.• Assisted providers and members with medical claims status, payment information, and eligibility in a professional and courteous manner.• Handled comments and complaints generated by phone or walk in.