Eligibility Consultant – Electronic
Are you passionate about helping individuals access the healthcare coverage they need? Do you have a strong understanding of electronic eligibility processes? Aetna is seeking an experienced Eligibility Consultant to join our team. In this role, you will be responsible for managing electronic eligibility systems and ensuring accurate and timely processing of eligibility data. This is an excellent opportunity for someone who thrives in a fast-paced, dynamic environment and is dedicated to delivering exceptional customer service. If you possess the required qualifications and are ready to make a positive impact on the healthcare industry, we want to hear from you!
- Manage and maintain electronic eligibility systems to ensure accurate and timely processing of eligibility data.
- Monitor system performance and troubleshoot any issues that may arise.
- Stay updated on changes and updates to electronic eligibility processes and ensure compliance with all regulations.
- Collaborate with cross-functional teams to gather and analyze data to improve system efficiency and accuracy.
- Develop and maintain relationships with key stakeholders, including healthcare providers and insurance brokers.
- Provide exceptional customer service to individuals seeking healthcare coverage.
- Conduct training sessions for internal team members on electronic eligibility processes.
- Proactively identify and resolve any potential issues with eligibility data.
- Assist in the development and implementation of new processes and procedures related to electronic eligibility.
- Stay updated on industry trends and best practices to continuously improve the eligibility process.
- Maintain accurate and organized records of eligibility data and system activities.
- Keep confidential information secure and adhere to all data privacy laws and regulations.
- Communicate any updates or changes in electronic eligibility processes to team members and stakeholders.
- Meet and exceed performance goals and metrics set by the company.
- Continuously seek opportunities for process improvement and make recommendations to management.
Knowledge Of Electronic Health Records (Ehrs): An Eligibility Consultant At Aetna Must Have A Thorough Understanding Of Ehrs And Their Implementation In The Healthcare Industry. This Includes Knowledge Of Various Ehr Platforms, Data Management, And Compliance Regulations.
Experience In Eligibility Determination: A Strong Background In Eligibility Determination Is Essential For This Role. The Consultant Must Be Able To Accurately Assess An Individual's Eligibility For Health Insurance Coverage Based On Their Personal And Financial Information.
Familiarity With Healthcare Laws And Regulations: Aetna Operates Within A Highly Regulated Industry, And It Is Crucial For An Eligibility Consultant To Have A Deep Understanding Of Healthcare Laws And Regulations. This Includes Hipaa, Aca, And Other State And Federal Regulations.
Analytical And Problem-Solving Skills: As An Eligibility Consultant, One Must Possess Strong Analytical Skills To Review And Interpret Complex Data. They Should Also Have Excellent Problem-Solving Abilities To Address Any Eligibility Discrepancies Or Issues That May Arise.
Communication And Customer Service Skills: Effective Communication And Exceptional Customer Service Are Essential For This Role. An Eligibility Consultant Must Be Able To Communicate Complex Information To Clients And Provide Excellent Service To Ensure Customer Satisfaction.
Communication Skills
Data Analysis
Time Management
Attention to detail
customer service
Problem-Solving
Medicare/Medicaid Knowledge
Eligibility Verification
Electronic Data Management
Health Insurance Expertise
Communication
Conflict Resolution
Emotional Intelligence
Leadership
Time management
creativity
Teamwork
collaboration
Adaptability
Problem-Solving
According to JobzMall, the average salary range for a Eligibility Consultant – Electronic in Plymouth, MN, USA is $40,000-$60,000 per year. However, this can vary depending on factors such as experience, education, and the specific company. It is best to research the salary range for your specific position and industry to get a more accurate estimate.
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Aetna Inc. is an American managed health care company that sells traditional and consumer directed health care insurance and related services, such as medical, pharmaceutical, dental, behavioral health, long-term care, and disability plans, primarily through employer-paid (fully or partly) insurance and benefit programs, and through Medicare. Since November 28, 2018, the company has been a subsidiary of CVS Health.
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