Data Support Specialist II - 25-179

We’re delighted you’re considering joining us!

At Hill Physicians Medical Group, we’re shaping the healthcare of the future: actively managed care that prevents disease, supports those with chronic conditions and anticipates the needs of our members.

Join Our Team!

Hill Physicians has much to offer prospective employees.  We’re regularly recognized as one of the “Best Places to Work in the Bay Area” and have been recognized as one of the “Healthiest Places to Work in the Bay Area.” When you join our team, you’re making a great choice for your professional career and your personal satisfaction.

De&I Statement:

At PriMed, your uniqueness is valued, celebrated, encouraged, supported, and embraced. Whatever your relationship with Hill Physicians, we welcome ALL that you are.

We value and respect your race, ethnicity, gender identity, sexual orientation, age, religion, disabilities, experiences, perspectives, and other attributes. Our celebration of diversity and foundation of inclusion allows us to leverage our differences and capitalize on our similarities to better serve our communities. We do it because it's right!

Job Description:

Under the supervision of the Enrollment Services Supervisor, provides data entry and research support for the maintenance of member demographics and enrollment data in the QNXT system and related databases. Maintain accuracy and production expectations based on department goals.

Job Responsibilities

• Create and maintain member module records; patient demographics, internal and external (COB) enrollment data and special handling alerts.
• Create internal call tracker requests and route to appropriate IT departments for resolution of member benefit rate code data.
• Research and release internal enrollment pended claims by utilizing the correct member record associated with the claim and assigning the correct internal and/or external enrollment segments for coordination of benefits.  Ensure that the claim is adjudicated accurately and/or denied with the appropriate denial reason codes.
• Effectively communicate with internal and external staff to obtain member enrollment information for problem resolution.
• Research and evaluate health plan enrollment data discrepancies by using the MS Access health plan enrollment file database(s) and on-line health plan websites.
• Determine and execute a best solution to resolve problems.
• Maintain accuracy as outlined in department goals.
• Maintain turnaround times as outlined in the department goals.
• Maintain a minimum productivity of 100%.
• Participate in periodic audits to ensure the integrity of the enrollment data.
• Maintain member enrollment documentation of all research and verified enrollment information.
• Complete special projects as assigned to meet department and company goals.
• Perform general administrative duties including, but not limited to, filing, faxing, copying, and mail distribution.
• Attend interdepartmental meetings as requested by Supervisor or Manager.
• Assist with staff training as required.

Required Experience

• Minimum of one year of experience.
• One year of recent managed-care experience with heavy emphasis on enrollment using an on-line system.
• Excellent written- and interpersonal-communication skills.
• Accurate and detail-oriented.
• Demonstrated flexibility and dependability.
• Excellent organizational skills.
• Working knowledge of MS Office desktop/PC applications.
• Demonstrated ability to exercise good judgment, prioritize multiple tasks, and problem solve under pressure of deadlines and resource constraints.
• Previous experience with the QNXT software application highly desirable.

Required Education

• H.S. Diploma/GED

Additional Information

Salary: $24 - $27 hourly

Hill Physicians is an Equal Opportunity Employer