This position is located in Avesis? Operations Department in the Operations Headquarters in Phoenix, Arizona.? Under general supervision, the Eligibility Lead facilitates the development and activities of an organized team of Eligibility Specialists by providing leadership, support and training. The TL will routinely monitor individual ESR and team performance relative to company policy and contractual performance standards and work with the Supervisor to make any needed schedule adjustments.? The TL will assist individual ESR?s with escalated eligibility issues as needed. The TL will provide routinely scheduled individual ESR reviews and performance coaching and track the performance objectives and skill development of each ESR team member. The TL is responsible for working with representatives from client organizations and Avesis Account Managers, Customer Service, Utilization Management, Quality Assurance and Claims department staff regarding determination of member eligibility for Avesis vision, dental and hearing program services. The Enrollment Lead works with the Eligibility Specialists, Avesis Information Technology (I.T.) department and Account Management to ensure electronic and paper documentation of eligibility from client organizations is updated in an accurate and timely manner.
Essential Job Functions
Receive electronic files of member eligibility, review for discrepancies, and update Avesis systems files as applicable
Process eligibility files into company membership database using current industry standards relative to HIPAA and 834-type file transmissions
Maintain enrollment spreadsheets for tracking and statistical purposes
Communicating clearly and effectively with ESR?s, representatives of contracted health plans and client organizations
Perform audits of group administration services relating to enrollment and eligibility records for commercial and government groups, process ID card requests, and perform other enrollment-related functions.
Auditing of ESR?s performance and effectively coaching them in refining their skills, system applications and adherence to policies and procedures.
Other duties as assigned