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Company Name:
Sutter Health
Approximate Salary:

Sacramento, California
United States
Position type:
Experience level:
Education level:

Eligibility Representative II

Eligibility Representative II analyzes monthly eligibility activity reports, reconciles current member lives reported by the various health plans. Responsible for knowing the contractual language stipulated in the health plans contracts as it relates to the management of the membership lives for all clients and all health plans. Assigns and maintains monthly membership lives appropriately to Primary Care Physicians (PCPs) based on health plan eligibility files and/or PCP open/closed rosters. Accurately updates, maintains, and retrieves eligibility information within Sutter Physician Servicess database.A. Education 1. High School Diploma or equivalent. B. Experience/Knowledge\: 1. Excellent customer service communication and proper telephone etiquette skills. 2. Experience in the Healthcare Industry in a customer service capacity. 3. Knowledge of pmpm capitation methodology of payment helpful. 4. Accounting or bookkeeping background in Healthcare/Managed Care environment helpful. 5. HMO and IPA experience helpful. 6. Good working knowledge of the managed care process preferred. C. Skills\: 1. PC and Intermediate data entry skills required. 2. Analytical skills in abstracting and compiling enrollment and capitation data using Access and Excel programs. 3. Must be detail oriented and have excellent written and verbal skills. 4. Skills in data collection techniques and record keeping, demonstrating attention to detail and consistent follow through. 5. Basic Math skills required. 6. Excellent customer service communication and proper telephone etiquette skills. 7. Ability to work independently with minimal direction. 8. Ability to operate a facsimile machine and copier. 9. Ability to work as a team member to meet contractual deadlines.