This position works directly with members and non-members to ensure that they have access to assistance in completing eligibility and redetermination screenings in a timely manner. The role includes conducting eligibility screenings that determine eligibility for other state funding and GPRA assessments. This position will also support operations with other administrative functions that could support departments such as clinical operations, network, compliance, and quality.
- Manage the daily task lists in TruCare for eligibility screenings that need to be completed.
- Perform eligibility screenings to determine member eligibility for various state funding programs and administer Government Performance and Results Act (GPRA) assessments.
- Help facilitate appropriate referrals for members who no longer meet state eligibility requirements or other applicable programs.
- Manage lists generated from the Enrollment department to identify members at risk of losing coverage and provide outreach.
- Follow up on alerts regarding member eligibility issues, offering support and outreach to members and their families.
- Document all actions, including phone calls and member interactions, in the centralized record system in a timely manner.
- Make recommendations for policy and procedure improvements focused on member retention, workflow efficiencies, and member satisfaction.
- Submit help desks tickets for issues that may be needed due to requirements of the screening or when there are issues with the medical record system.
- Perform administrative functions, including phone calls, emails, or other communications that help support the operations of the organization.
- Demonstrate ability to meet performance metrics, including volume-based targets for calls, eligibility screenings, and surveys.
- Assist with managing Authorization to Use and Disclose (AUD) process.
The job duties listed above are representative and not intended to be all-inclusive of what may be expected of an employee assigned to this job. A leader may assign additional or other duties which would align with the intent of this job, without revision to the job description.
Other Job Requirements
Responsibilities
2+ years of relevant experience in the human services field required.
Proven ability to build relationships and collaborate with providers and members.
High level of accountability and responsibility for outcomes.
Excellent interpersonal, verbal, and written communication skills.
Strong problem-solving skills and creativity.
Proficiency with Microsoft Office products and ability to quickly learn new software applications.
General Job Information
Title
Eligibility Screener and Operations Support
Grade
19
Work Experience - Required
Behavioral Health, Healthcare
Work Experience - Preferred
Education - Required
GED, High School
Education - Preferred
Bachelor's
License and Certifications - Required
License and Certifications - Preferred
Salary Range
Salary Minimum:
$37,725
Salary Maximum:
$56,595
This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.
This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing.
Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.
Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
