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Danville, Pennsylvania
Posted: 11-Jun-25
Location: Irving, Texas
Internal Number: 260996
Summary:
The Health Plan Enrollment Representative will prioritize and coordinate daily tasks and projects. The Enrollment staff ensures that all data entry is accurate including demographic and financial information for each account. This job?s core responsibilities include, but are not limited to enrolling new members, update existing members, review/update eligibility, and disenroll members in the appropriate applications. This associate will be responsible for researching complex problems using available resources and implementing solutions to mitigate any future issues. This job will be responsible for working various work queues, and other duties as assigned. The core responsibilities will be aligned with the timely and accurate entry of all phases of the enrollment/billing process for an exceptional level of service to our members. This job requires professional appearance, behavior, and good communication skills. Enrollment Representatives require dependability, flexibility, and teamwork.
This job will be responsible for applying for a Common Access Card (CAC) and will need required approval to be in good-standing by the government for utilizing various databases of information on uniformed services members, U.S. sponsored foreign military, DoD and uniformed civilians, as well as other personnel as directed by the DoD, and their family members. The CAC application process supports the CHRISTUS US Family Health Plan (USFHP) TRICARE Operation Manual (2015 Edition ? T17; 2021 Edition ? T5) Chapter 14, Section 1 Contracting Requirements.
Responsibilities:
- Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
- Accurately inputs all required data elements for scheduling and registration, including member demographic, financial information, and relevant notes associated with the encounter.
- Calculates and collects the estimated member portion based on benefits and contract reimbursement as well as prior balances.
- Represents the Enrollment department in a professional, courteous manner at ALL times.
- Supports the department in achieving established performance targets.
- Demonstrates contribution and achievement of department collection initiatives.
- Maintain confidentiality for all customers.
- Enrollment activities for members via paper, file transfer, or internet enrollment processing
- Maintain knowledge and expertise in eligibility, enrollment and billing; and program specifications for U.S. Family Health Plan, Medicare, Medicaid, and or the Federal marketplace.
- Maintain detailed tracking of each function within the enrollment and disenrollment process including correspondence and accuracy of member ID cards.
- Communicates verbally and in writing with members, third parties and other departments as required to facilitate the enrollment, disenrollment and billing processes.
- Responds to internal and external customer inquiries regarding eligibility and related functions.
- Enters information during the enrollment process that assists claims personnel in claim adjudication including COB.
- Consistently meets or exceed department and company standards and expectations including but not limited to quality, productivity and attendance.
- Responsible for member correspondences.
- Perform other duties as assigned
- Responsible for initial and/or renewal application for Common Access Card (CAC) to support the CHRISTUS USFHP product line of business. Must complete various government documentation and Cyber Security Training for complete approval from the TASS office by entering information that is correct to the best of the applicant?s knowledge.
- Communicates verbally and in writing with the Facility Security Officer (FSO) during the entirety of the CAC process and completion. This includes undergoing an extensive background check with the government, completing fingerprinting, and requesting permission from the DHA Contracting Officer (KO).
Requirements:
- High School Diploma
- Common Access Card (CAC) - be obtained within 6 months and kept current
Work Type:
Full Time
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