THE EXCITING CHALLENGE
You can make a difference in the San Francisco communities. We are currently looking for a full-time Member Data Coordinator.
The Member Data Coordinator is responsible for the accuracy of health plan member data pertaining to eligibility, PCP assignments, coordination of benefits, and other related member coverage. Duties include correcting member eligibility in QNXT, resolving eligibility problems for providers/vendor groups, assigning PCP for members, identifying other health coverage of members by making outreach calls, and achieving organizational and departmental goals.
WHAT YOU WILL DO
- Manually reconcile and correct eligibility discrepancies within the required time frame.
- Handle eligibility discrepancy issues for vendor groups and network providers and find resolutions.
- Manually assign and reassign a PCP, and maintain attributes for members.
- Manually correct and update the eligibility for Healthy Workers members and City Workers members including its Cobra coverage.
- Locate information of member’s other health coverage and Third Party Liability and enter it to DHCS website. Follow up until eligibility is changed.
- Contact Medi-Cal to correct information listed in MC website.
- Manage COB information for members with dual coverage.
- Work with other health coverage vendors to update QNXT on member’s eligibility and coordinate benefits.
- Identify primary and secondary eligibility on VA cases.
- Support Customer Service Department for phone back-up and administrative duties.
- Comprehend and keep abreast of all information of the job, including but not limited to new processes, procedures, program or plan requirements, and new HIPAA requirements.
- Accessing and utilizing information resources to provide the most accurate and thorough responses, in accordance with departmental policies.
- Works effectively and efficiently in a team with minimal supervision in a diverse and performance based environment where productivity is measured.
- Maintain records and regular written reports as needed.
- Performs duties requested by the supervisor.
WHAT YOU WILL BRING
- High school graduate or GED; Bachelor’s degree desired
- Experience in member eligibility information and verification highly desirable
- Knowledge of QNXT system especially with the Member Module desired
- Extensive skill with call center environment and ACD system desired
- Familiarity and understanding of California managed care and medical terminology preferred
- Ability to interpret and comply with complex rules and regulations
- Experience in MS Office, Excel, Word, Outlook, Access, SharePoint or other database applications
- Strong verbal and written communication skills with understanding of confidentiality related to sensitive information
- Organized, customer service oriented, and detail oriented
- Schedule: Monday - Friday, 8:30-5:30
San Francisco Health Plan (SFHP) is a an award winning, managed care health plan whose mission is to provide affordable health care coverage to the underserved low and moderate-income residents in San Francisco county. San Francisco Health Plan is chosen by eight out of every ten San Francisco Medi-Cal managed care enrollees and its 140,000+ members have access to a full spectrum of medical services including preventive care, specialty care, hospitalization, prescription drugs, and family planning services. SFHP was designed by and for the residents it serves, and takes great pride in its ability to accommodate a diverse population that includes young adults, seniors, and people with disabilities.
San Francisco Health Plan is an Equal Opportunity Employer (EOE) M/F/D/V
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.