Insurance Verification Specialist

Schedule 530a - 130p - hybrid (2 days in office and 3 days remote)

Community Medical Services (CMS) is hiring an Enrollment Specialist. This role will complete verification of client eligibility on various, Medicaid, Medicare & Commercial Provider Portals. Maintain day to day enrollment and demographic processing in Community Medical Services Inc. EHR and EMR for all line of business. Create, update and submit all Demographics to applicable Payers. Research rejected Claims related to member data and resolve discrepancies. Provide necessarily follow up to resolve errors, this would include communication with Operations and Clinical staff.

As you join our mission to help those suffering from substance use disorders reclaim their lives, expect to thrive in a comfortable, welcoming, and fun environment where you are valued for the work you do, championed by passionate leaders, and equipped with the tools and ongoing training you need to achieve your goals.

Along the way, we’ll invest in your well-being through a benefits package for full-time employees that includes

• Subsidized medical, dental, and vision insurance
• Health savings account
• Short and long-term disability insurance
• Life insurance
• Paid sick, vacation, and holiday time
• 401K retirement plan with match
• Tuition and CME reimbursement up to 100%
• Employee assistance program to support your mental health and wellness
• Ongoing professional development
  
  
  

Responsibilities

• Verification of client eligibility on various, Medicaid, Medicare & Commercial Provider Portals.
• Respond to inquiries, submitted to Departmental Inbox (Microsoft Outlook).
• Maintain day to day enrollment and demographic processing in Community Medical Services Inc. EHR and EMR for all line of business.
• Identify opportunities and recommend actions to improve the efficiency and accuracy of processes.
• Perform audits and analyses on completed member data in core systems.
• Create, update and submit all Demographics to applicable Payers.
• Research rejected Claims related to member data and resolve discrepancies.
• Provide necessarily follow up to resolve errors, this would include communication with Operations and Clinical staff.
• High school diploma or equivalent.
• 3+ years of transaction processing, data reconciliation, membership records, or related managed care/healthcare experience.
• Experience in a managed care environment with provider information systems preferred.
• Must be comfortable with reviewing at least 1000k client records a month to validate insurance or client balances.
• Must be comfortable with reviewing client information in the 9 states, where business rules are different.
  
  
  

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