Data Support Specialist II - 26-53

We’re delighted you’re considering joining us!

At Hill Physicians Medical Group, we’re shaping the healthcare of the future: actively managed care that prevents disease, supports those with chronic conditions and anticipates the needs of our members.

Join Our Team!

Hill Physicians has much to offer prospective employees.  We’re regularly recognized as one of the “Best Places to Work in the Bay Area” and have been recognized as one of the “Healthiest Places to Work in the Bay Area.” When you join our team, you’re making a great choice for your professional career and your personal satisfaction.

DE&I Statement:

At PriMed, your uniqueness is valued, celebrated, encouraged, supported, and embraced. Whatever your relationship with Hill Physicians, we welcome ALL that you are.

We value and respect your race, ethnicity, gender identity, sexual orientation, age, religion, disabilities, experiences, perspectives, and other attributes. Our celebration of diversity and foundation of inclusion allows us to leverage our differences and capitalize on our similarities to better serve our communities. We do it because it's right!

Job Description:

Under the supervision of the Enrollment Services Supervisor, provides data entry and research support for the maintenance of member demographics and enrollment data in the Epic Tapestry system and related databases. Maintain accuracy and production expectations based on department goals.

Job Responsibilities:

• Create and maintain member module records, patient demographics, enrollment data, and special handling alerts from both internal and external data source documents, such as the HMO member eligibility reports, EDI enrollment queues, and health plan web sites.

• Create internal call tracker/CRM request and route to appropriate IT departments for resolution of member benefit rate code data.

• Research and release internal enrollment pended claims, CRM request, referrals/authorizations, and other work queues by utilizing the correct member record associated with the claim and assigning the correct enrollment/coverage.

• Effectively communicate with internal and external staff to obtain client information for problem resolution.

• Research and evaluate health plan enrollment data discrepancies and incoming issues from other departments regarding client information, such as current eligibility status, plan information, historical data, and contracts/benefits.

• Determine and execute the best solution to resolve problems.

• Maintain client files and documentation of all research and verified information

• Set up new member records and flag pertinent records for necessary contract assignment.

• Use of multi-media technology to aid in research, to include but not limited to health plan online systems, voice response systems, internet, e-mail, phone, and fax.

• Perform general administrative duties including, but not limited to, filing, faxing, copying, and mail distribution.

• Prepare necessary paperwork to notify other departments of system changes, such as member moves and changes in PCP status.

• Maintain a 97% accuracy level when entering data.

• Maintain a minimum productivity of 100%.

• Maintain turnaround times as outlined in department P&P.

• Attend interdepartmental meetings as requested by Supervisor or Manager.

• Assist with staff training as required.

Required Experience

• Minimum of one year of experience.

• One year of recent managed-care experience with heavy emphasis on enrollment using an online system.

• Excellent written and interpersonal communication skills.

• Accurate and detail oriented.

• Demonstrated flexibility and dependability.

• Excellent organizational skills.

• Ability to work independently to meet department turn around time and performance expectations.

• Working knowledge of CPT, ICD, MS Office desktop/PC applications.

• Demonstrated ability to exercise good judgment, prioritize multiple tasks, and problem solve under pressure of deadlines and resource constraints.

• Previous experience with the Epic Tapestry application is highly desirable.

Required Education

• H.S. Diploma/GED

Additional Information

Salary: $26 - $29 Hourly

Hill Physicians is an Equal Opportunity Employer