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Job Description
Job Summary
Responsible for analyzing and interpreting documentation received in Revenue Cycle from sales, agents, and employer groups to accurately set-up and configure basic to moderately complex fully-funded benefit options, group structures, and membership using the OnBase and Facets systems. Conducts moderately complex analysis of Facets and OnBase information to provide issue resolution and respond to inquiries related to group and member set-up. Assists on project teams as assigned.
Essential Functions
Analyze and interpret documentation received from Sales (EGI, NGI, Revisions, Client Fact Sheet, etc.) to determine Facets setup, configuration, and accurately build a variety of fully-funded benefit options, group structures, and enroll members.
Conduct moderately complex research as necessary to effectively resolve customer issues and respond to customer inquiries regarding group and member status through Facets documentation, phone calls, written correspondence, and approved form letters.
Participate in cross-functional training opportunities and process improvement initiatives within Revenue Cycle during the non-peak open enrollment periods.
Works under minimal direction guided by established policies and procedures.
Analyze multiple reports from various internal and external sources to determine and implement appropriate action to reconcile group/member discrepancies.
Maintain a basic understanding of all internal and external computer systems and reports that impact the group set-up and member enrollment process.
Participate in implementation workgroups with Sales and other business owners to ensure a transparent onboarding or renewal process for Key and Performance Guarantee groups.
Monitors and prioritizes work in the OnBase workflow queues to ensure that our department Service Level Agreements are met.
Qualifications
Required High School Diploma or equivalent
Preferred Associate's Degree in business or health care related field
2 years of relevant experience in the healthcare industry or related field Required
Experience with FACETS Software in benefit and/or group configuration/maintenance or claims Preferred
Primary Location
SITE - Priority Health - 1239 E Beltline - Grand Rapids
Department Name
PH - Revenue Cycle Fulfillment
Employment Type
Full time
Shift
Day (United States of America)
Weekly Scheduled Hours
40
Hours of Work
8 a.m. - 5 p.m.
Days Worked
Monday - Friday
Weekend Frequency
N/A
Accommodation Notice: If you are a qualified individual with a disability, you may request a reasonable accommodation in Spectrum Health's application process. Contact us at 616-486-SHHR (7447).
Spectrum Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, sexual orientation, veteran status, or any other legally protected
category. See more here (https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf) .
Who We Are
Spectrum Health is a nationally recognized not-for-profit health system, offering a full continuum of health services through our health plan, medical group and hospital group. As an integrated health system, we are able to work together across all facilities, employees and providers to create exceptional, consumer-focused interactions.
Spectrum Health is redefining what it takes to improve the health of our communities and introducing new and innovative ways for consumers to access high-quality, low-cost care so that they can connect with us for a lifetime of health.
We strive to provide one Spectrum Health experience: a consistent, high-quality, seamless health journey for consumers; no matter where, when or how they interact with us. The result is better health outcomes for the thousands of individuals, families and communities we serve.
We are the region's largest employer, with corporate offices located in Grand Rapids, Michigan. Spectrum Health Hospital Group and Spectrum Health Medical Group are consistently recognized for the exceptional care they provide. Priority Health is among the largest health system-sponsored health plans in the U.S. and offers extensive experience serving large and small employer groups, individuals, Medicare Advantage, Healthy Michigan Plan and Medicaid populations.
Since 2010, Spectrum Health has been listed five times among the 15 Top Health Systems in the U.S. by Truven Analytics™. Click here (https://www.spectrumhealth.org/about-us/quality-safety-and-patient-experience/awards) to see a complete list of our safety, quality and patient experience awards.