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 Services-s database.
1. High School Diploma or equivalent.
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.
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.
**Primary Location:** California, Greater Sacramento Area, Sacramento
**Organization:** Sutter Physician Services
**Employee Status:** Regular
**Employee Referral Bonus:** No
**Position Status:** Non-Exempt
**Job Shift:** Day
**Shift Hours:** 8 Hour Shift
**Days of the Week Scheduled:** Monday-Friday
**Weekend Requirements:** Other
**Schedule:** Full Time
**Hrs Per 2wk Pay Period:** 80
All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, marital status, sexual orientation, registered domestic partner status, sex, gender, gender identity or expression, ancestry, national origin (including possession of a driver's license issued to individuals who did not present proof of authorized presence in the U.S.), age, medical condition, physical or mental disability, military or protected veteran status, political affiliation, pregnancy or perceived pregnancy, childbirth, breastfeeding or related medical condition, genetic information or any other characteristic made unlawful by local, state, or federal law, ordinance or regulation. External hires must pass a background check/drug screening. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state, and local laws, including but not limited to the San Francisco Fair Chance Ordinance.
Sutter Health values and supports the unique talents and strengths that each employee brings to our organization. As a result, you are empowered to apply your passion for healing in innovative ways to care for patients and their families.
Collaborating with the best and the brightest means a dynamic, fulfilling work experience for you – and excellent, personalized care for all those we serve.