Eligibility Consultant - Electronic

Job Description
As an Eligibility Consultant you will have the opportunity to develop and maintain strong client relationships with our Medicare Advantage Group customers.  You will be responsible for administrating the groups’ eligibility in accordance with the CMS Medicare Advantage guidelines. The Eligibility Consultant will maintain enrollment databases and coordinate electronic transfer of eligibility data and must have a full understanding of Medicare Guidelines and the enrollment processes.

Fundamental Components
As an Electronic Eligibility Consultant, your success will be driven by meeting client satisfaction.  Using your skills and knowledge to define problems, participate in improvement efforts, and manage processes to ensure our internal and external customer needs are met. The ability to deliver results for our clients will be a key factor to your success in this role.
You will accomplish this by:
   •        Administer client needs where you respond, research, and resolve eligibility and other enrollment related discrepancies involving member specific information.
   •        Participate in inter-departmental process reviews and training including special projects
   •        Participate in client meetings (Conference Calls and/or Onsite meetings)
   •        Analyze reports and communicate results to clients as you complete data entry requirements for finalizing new enrollment information as well as for changes and/or terminations.
   •        Reconcile enrollment discrepancies between Aetna and clients/vendors
   •        Participate in developing client action plans by working directly with clients/vendors, sales and other assigned account team members to achieve positive service outcomes
•           Applies Centers for Medicare & Medicaid Services guidance and Aetna policies associated with technical requirements and account structure in addressing eligibility matters.
   •        Ensures all transactions interface accordingly with downstream systems; tests and validates data files for new or existing clients using system tools and tracks results to avoid potential problems and better address on-going service issues.

Background Experience

• Candidate should have a strong command of Federal Medicare guidelines/requirements & Aetna Medicare Advantage policy
• Attention to detail and accuracy
• Problem solving skills
• Strong organization skills
• Understands the impact of work to other teams and downstream support areas
• Ability to analyze and research data to make appropriate corrections as necessary
• Strong verbal and written communication skills

Additional Job Information
Ability to analyze and research data to make appropriate corrections as necessary.Understands the impact of work to other teams and downstream support areas.Strong verbal and written communication skills.Sound understanding of system errors and how to resolve efficiently.Strong organization skills.Problem solving skills.Attention to detail and accuracy.

Education
High School diploma, G.E.D. or equivalent experience

Percent of Travel Required
0 - 10%