Eligibility Operations Team Lead

HMS Irving , TX 75061

Posted 3 months ago

HMS makes the healthcare system work better for everyone. We fight fraud, waste, and abuse so people have access to healthcarenow and in the future. Using innovative technology and powerful data analytics, we help government and commercial payers reduce costs, increase quality, and achieve regulatory compliance. We also help consumers take a more active role in their own health. Each year, we save our clients billions of dollars while helping people live healthier lives. At HMS, you will develop new skills and build your career in a dynamic industry while making a difference in the lives of others.

We are seeking a talented individual for a Eligibility Operations Team Lead who ensures that the assigned team completes the following tasks: verifying, documenting and coordinating information needed to process applications and other Eligibility Operations assignments. Conducting training and support to ensure health insurance policy analysis, documentation verification, employer coordination and customer service is being completed while ensuring accurate data entry, validation and timely processing.

Essential Responsibilities:

  • Acts as the first point of escalation for Eligibility Operations Advisors.

  • Resolve any escalated project issues to address customer satisfaction and determine root cause.

  • Provide feedback to Supervisor on staff performance including concerns and appropriate recognition.

  • Ensures that the assigned team completes all tasks as required.

  • Train and mentor all new hires as well as existing staff on systems, policies, procedures and guidelines of the Eligibility Operations projects.

  • Manage check process to ensure a thorough quality review is completed on all active cases prior to checks being issued.

  • Lead the work distribution to ensure assignments are clearly communicated to meet team goals and objectives.

  • Provide enrollment assistance and HIPP program information over the phone to beneficiaries as needed.

  • Assists with escalated calls and other inquiries from members and client contacts.

  • Verify, document and investigate the presence of health care coverage for Medicaid recipients and their families.

  • Assist in the identification of beneficiaries of beneficiaries that may qualify for the HIPP program.

  • Complete inventory and performance reports as needed.

  • Obtain and/or verify all items related to eligibility and enrollment into the HIPP program.

Non-Essential Responsibilities:

  • Performs other functions as assigned

Knowledge, Skills and Abilities:

  • Ability to organize well.

  • Ability to prioritize.

  • Ability to provide and represent professionalism in job.

  • Ability to motivate individual in a team atmosphere

  • Ability to practice flexibility and adaptability in the work place.

  • Ability to work proficiently with Microsoft Word and Excel and navigate internet skillfully.

  • Ability to analyze information and use logic and process to address work-related issues and problems.

  • Ability to operate with strong interpersonal skills.

  • Ability to be careful and thorough about detail.

  • Ability to perform data entry accurately.

  • Average manual dexterity in use of a PC, phone, 10 key, sorting, filing and other office machines.

  • Ability to handle conflict appropriately and constructively.

  • Ability to apply problem solving skills.

  • Ability and desire to train others.

  • Working knowledge of HIPAA privacy and Security rules.

  • Ability to perform well in team environment.

  • Ability to work independently to meet objectives.

  • Ability to meet deadlines.

  • Ability to handle pressure and deadline oriented project demands as well as manage multiple initiatives.

Work Conditions and Physical Demands:

  • Primarily sedentary work in a general office environment

  • Ability to communicate and exchange information

  • Ability to comprehend and interpret documents and data

  • Requires occasional standing, walking, lifting, and moving objects (up to 10 lbs.)

  • Requires manual dexterity to use computer, telephone and peripherals

  • May be required to work extended hours for special business needs

  • May be required to travel at least 10% of time based on business needs

Minimum Education:

  • High School Diploma or equivalent required

Minimum Related Work Experience:

  • Min. 1 year experience working in an Eligibility Operations Department and 1 year experience in a similar role

  • or

  • Min. 2 years of experience working in an Eligibility Operations Department

  • or

  • Min. 4 years of experience in insurance industry, health care or government sponsored health insurance to include customer service and medical billing knowledge or similar quality assurance related experience

  • Knowledge of health care terminology and Medicaid programs are required

Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time.

EEO including disability/veteran


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Eligibility Operations Team Lead

HMS