Eligibility Coordinator / 189

Job Status: Full Time, Employee Job Category: Administrative/Clerical Career Level: Experienced (Non-Manager) Reference Code: 189 Visit us on the web http://apshealthcare.com/ APS was founded as a behavioral healthcare company and has evolved into a specialty healthcare company that offers customized, integrated healthcare solutions across two major product lines: care management and behavioral healthcare services. The company has capitalized on its experience in behavior change to create physical and mental healthcare programs that are industry renowned. The use of an integrated approach to healthcare for the mind and body has allowed APS to be more effective in improving the quality and effectiveness of care. Today, APS is a pioneer in providing health and disease management services while retaining its position as one of the leading behavioral healthcare organizations in the United States. In fact, APS is the only specialty healthcare company with extensive experience in health management, behavioral healthcare, employee assistance programs (EAP), informatics and quality review/oversight programs. Eligibility Coordinator / 189 Position Description:This is an aggressive position that allows for interdepartmental expertise in working with the System Administration to develop and maintain various system applications, problem solve software issues, and evaluate/update workflows to meet changes that occur as needs evolve. He/she will develop and maintain security and confidentiality standards, as well as internal systems for compliance and reporting requirements. This professional is also responsible for coordinating reports and audits and customer/technical interfaces. Focus is placed on continual improvement in the delivery of service to APS customers, both internal and external and compliance with governmental and other applicable standards. APS Healthcare employees are expected to maintain a positive work atmosphere through communicating and behaving in a manner that is courteous and respectful of customers, clients, co-workers, and supervisors.ESSENTIAL JOB FUNCTIONS:1. Verifies eligibility for APS members on various databases.2. Serves as technical liaison with IS staff for system development and implementation of new and existing business.3. Participates in implementation of new products and contracts and ensures departmental communication.4. Performs System Administrator functions on various databases (e.g. sets up letter templates, loads benefits in system, and creates new users, add and maintain dropdown field choices)5. Performs daily, weekly and monthly eligibility imports of member, providers and facilities.6. Performs daily, weekly, and monthly audits on various databases.7. Creates ad hoc reports utilizing the appropriate data management systems as needed.8. Performs daily authorization extracts for customers. 9. Runs system reports, requests information to update reports, and provides report-building input. Generates additional reports as needed.10. Maintains thorough working knowledge of all products and data management systems as identified and assigned.ESSENTIAL JOB FUNCTIONS: Cont…11. Participates, as an active member on teams, committees, and other organization needs as identified and assigned.12. Assists in the coordination of services for major customers.13. Responsible for the troubleshooting of technical problems.14. Facilitates service delivery and quality by actively seeking to enhance products, services, and efficiency.15. Maintains responsibility for preserving the member’s confidentiality. This includes recognizing that member information is disseminated only per signed release, as mandated by state and/or federal law, and on a need to know basis. A yearly confidentiality statement will be reviewed and signed.16. Performs other duties and participates in special projects as assigned. Minimum Education: High School diploma or equivalent. Minimum Experience: Two years experience in an office environment with emphasis on administrative and /or clerical support and customer service. Previous claims / UM/ CM/ DM experience in health care/ insurance is mandatory. Experience in research, able to extract information from printed and automated resources on a regular basis. Other Qualifications:• Strong verbal communication and telephone skills.• Excellent follow-up skills.• Excellent organizational skills.• Strong keyboarding skills; typing, word processing, data entry.• Ability to maintain friendly and professional demeanor in a fast-paced work environment.• Ability to work independently as well as part of a team.• Knowledge of mental health and medical healthcare industry or similar background helpful.• Excellent working knowledge of various relational databases including Microsoft Access, Crystal Reports• Microsoft Word, Excel, and Outlook.The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel as classified.