Eligibility Specialist II

Position Purpose: Maintain membership records system related to the qualifications a person or dependent must meet for coverage under the State contract or agreement
Provide timely, efficient support for the eligibility load process and coordinate with IT to resolve issues
Research and correct errors in membership and PCP (Primary Care Physician) data input within the Amisys system
Complete monthly reconciliation of remittance files and resolve any discrepancies
Collaborate with IT and other functional departments to develop and implement new products or changes to existing products, including UAT testing
Coordinate the provider capitation process to ensure accurate and timely payments to providers
Participate in eligibility release planning to identify any system changes and ensure files are complete and process timely
Provide input on process improvement initiatives and update policies and procedures for eligibility and enrollment related activities
Develop training materials and train new staff on eligibility and enrollment procedures
Generate internal ad-hoc reports and analysis as needed.
Education/Experience: High school diploma or equivalent. 4 years of member enrollment, membership eligibility, member services, or data analysis experience. Knowledge of Medicaid managed care programs and practices, preferably for the assigned State. Experience with the Amisys and CRM system preferred.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

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