Company: SCAN Health Plan
Location: Long Beach
Posted on: May 12, 2022
As one of the nation's largest not-for-profit Medicare Advantage
plans, serving more than 200,000 members in California, SCAN Health
Plan has been a mission-driven organization dedicated to keeping
seniors healthy and independent for over 40 years. SCAN employees
are passionate about what they do, and understand that success is
based on achieving the mission. Employees are afforded with the
training and tools necessary to do their jobs and are rewarded for
their efforts and recognized as experts in their fields. To learn
more, visit scanhealthplan.com or follow us on social media:
LinkedIn ; Facebook ; and Twitter . The jobResponsible to resolve
discrepancies and prepare eligibility related findings to Analyst
Team and/or management. To minimize discrepancies and identify and
investigate member data between plan membership systems and
Medicare by reconciling, entering, correcting, tracking,
monitoring, and deleting member information as necessitated to
maintain accurate records.You
- Identify and respond to information requests from internal
business areas, external vendors, and regulatory agencies by
participating in process design sessions and reviewing enrollment
data reports from CMS, and other regulatory agencies.
- Ensure the incoming and outgoing data is accurate and compliant
with the regulatory requirements by documenting process work flows
and Policies and Procedures.
- Generate enrollment data files, QA the files with other
departments, and submit to regulatory agencies by working with the
Analyst staff to automate and establish reconciliation
- Coordinate the resolution of all rejected transactions (i.e.
Eligibility PDE and Encounter Rejects) from regulatory agencies by
researching errors, identifying root causes and reporting findings
to Management and internal business areas.
- Process member applications by reviewing data for deficiencies;
assigning codes to data; establishing data entry priorities, and
resolving discrepancies by using departmental policies and
- Enter member data by inputting alphabetic and numeric
information into ika (Visiant) Systems according to screen format
including benefit assignment, group affiliation, provider
selection, billing information, revenue codes and appropriate cross
- Verify entered data by reviewing, correcting or updating data
assisting in the regulatory submission and reply transactions.
- Verify eligibility for enrollment using state and federal
- Prepare eligibility report mailings by generating, reviewing
and distributing eligibility information to providers within
- Prepare member correspondence, including member letters, by
printing, reviewing and mailing.
- Complete requests and provide information by answering
questions and inquiries, by professionally representing the
department to others, referring inquires; generating telephone or
written responses to inquiries.
- Assure accurate data from regulatory system reply by utilizing
departmental systems to run reports and collect and analyze
- Bring discrepancies, between member data and various systems,
to a resolution by corresponding with member or federal
entities.Required: G.E.D / High School
- 1+ years Call Center experience.
- Experience in Medicare managed care health plan preferred.
- Experience working with ika (Visiant) and/or other healthcare
- Extensive simultaneous computer and telephone usage.
- Strong interpersonal skills, including excellent written and
verbal communication skills.
- Strong organizational skills; Ability to multitask.
- Ability to appropriately maintain confidentiality.
- Strong analytical and critical thinking skills, required.
- Proficiency in a second language required (includes, but not
limited to, Korean, Spanish, Tagalog, Cantonese, Mandarin,
Vietnamese, Farsi, and Russian).What's in it for you?
- A competitive compensation and benefits program -
- An annual employee bonus program
- Robust Wellness Program
- Generous paid-time-off (PTO)
- Ten paid holidays per year, plus 1 additional floating
- Excellent 403(b) Retirement Saving Plan with employer
- Robust employee recognition program
- A work-life balance
- An opportunity to become part of a team that makes a difference
to our members and our community every day!To ensure a healthy and
safe work environment, if you are selected for this position, your
job offer with SCAN Health will be contingent upon being fully
vaccinated and providing proof of your COVID-19 vaccine within 3
days after your start date. Generally, you are considered fully
vaccinated 14 days after receiving the last dose, as recommended by
the manufacturer, of a vaccine that has been authorized by the FDA
for use in the United States, including vaccinations that have been
approved pursuant to an Emergency Use Authorization. If fully
vaccinated outside of the United States, the vaccination must be
listed for emergency use by the World Health Organization (WHO). If
you cannot receive the vaccine because of a disability/medical
reason or sincerely-held religious belief, you may request an
accommodation to this requirement by contacting -COVID-19
Vaccination Policy . Learn more about the COVID-19 vaccination here
We're always looking for talented people to join our team!
Qualified applicants are encouraged to apply now!At SCAN we believe
that it is our business to improve the state of our world. Each of
us has a responsibility to drive Equality in our communities and
workplaces. We are committed to creating a workforce that reflects
our community through inclusive programs and initiatives such as
equal pay, employee resource groups, inclusive benefits, and more.
-SCAN is proud to be an Equal Employment Opportunity and
Affirmative Action workplace. Individuals seeking employment will
receive consideration for employment without regard to race, color,
national origin, religion, age, sex (including pregnancy,
childbirth or related medical conditions), sexual orientation,
gender perception or identity, age, marital status, disability,
protected veteran status or any other status protected by law. A
background check is required. #LI-JR1QualificationsSkillsBehaviors:
Motivations:EducationExperienceLicenses & CertificationsEqual
Opportunity Employer/Protected Veterans/Individuals with
DisabilitiesThe contractor will not discharge or in any other
manner discriminate against employees or applicants because they
have inquired about, discussed, or disclosed their own pay or the
pay of another employee or applicant. However, employees who have
access to the compensation information of other employees or
applicants as a part of their essential job functions cannot
disclose the pay of other employees or applicants to individuals
who do not otherwise have access to compensation information,
unless the disclosure is (a) in response to a formal complaint or
charge, (b) in furtherance of an investigation, proceeding,
hearing, or action, including an investigation conducted by the
employer, or (c) consistent with the contractor's legal duty to
furnish information. 41 CFR 60-1.35(c) Keeping Seniors Healthy and
Keywords: SCAN Health Plan, Long Beach , Reconciliation Specialist, Other , Long Beach, California
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