Enrollment Specialist
CurrentPerform recertification calls and follow up calls.Represents patients at HRA office; obtain back coverage to ensure that agency receives payment for services rendered to patient.Reviews all surplus cases to ensure that payments are being received are being adhere toResearches and resolves Medicaid issues to ensure that codes are removed when appropriate, to allow agency to be paid for services rendered.Resolves Medicaid ineligible/recertification issues.Follows up with HRA… Show more Perform recertification calls and follow up calls.Represents patients at HRA office; obtain back coverage to ensure that agency receives payment for services rendered to patient.Reviews all surplus cases to ensure that payments are being received are being adhere toResearches and resolves Medicaid issues to ensure that codes are removed when appropriate, to allow agency to be paid for services rendered.Resolves Medicaid ineligible/recertification issues.Follows up with HRA or LDSS to ensure eligibility discrepancies are corrected.Gathers and submits supporting documentation for cases with eligibility discrepancies and ensures Integra receives claim remissions for the appropriate time periods.Maintains accurate record keeping of cases referred to HRA or LDSS.Track and manage surplus adjustments received from LDSS and HRA.Reconciles enrollment discrepancies and determine the appropriate follow up actions.Compile and analyze data identifying trends and communicating them to management.Supports enrollment staff in researching and resolving eligibility issues.Tracks and reports on surplus members and identifies unresolved cases and works with the vendor to resolve them.Serve as Coordinator between vendor and Integra for data transfers.Assist the Director and Manager on projects as needed. Show less
