Workplace Type: Onsite (Hybrid Potential)
Employment Type: FT
Job Location: Barberton, OH
As an Eligibility Specialist at CHM, your role is pivotal in developing, maintaining, and enhancing the tools, processes, resources, and relationships that support the Eligibility Review Team (ER-Team) in becoming subject matter experts (SMEs) in eligibility matters. In this critical role, you will contribute to the efficiency and effectiveness of CHM’s eligibility review processes while upholding the organization’s values and mission.
What We Offer
- Compensation based on experience.
- Faith and purpose-based career opportunity!
- Fully paid health benefits
- Retirement and Life Insurance
- 12 paid holidays PLUS birthday
- Lunch is provided DAILY.
- Professional Development
- Paid Training
Essential Job Functions:
Team Development and Expertise
- Establish and maintain strong relationships with CHM staff and membership to serve as a resource and subject matter expert on eligibility matters.
- Ensure prompt attendance in team meetings with prepared cases and assignments. Verify that meeting agendas are completed, and topics are ready for discussion.
- Facilitate the integration of CHM’s message from Executive Leadership within the ER-Team, fostering a culture aligned with the organization’s values and goals.
- Collaborate with various departments to develop tools, processes, and resources that support the operations of the Eligibility Review Board (ERB). Manage relationships between departments to ensure seamless communication and cooperation.
- Prepare information and resources and support ERB-related training. Organize the training schedule and ensure training materials are accurate and complete.
- Ensure that assigned projects are appropriate and on track. Provide support to the ER-Team when needed to ensure project success.
- Manage the process of resolving issues raised by the ERB Team. Conduct periodic audits to ensure that resolutions meet established standards. If unable to resolve, refer the issues to the ERB-Supervisor (ERB-S).
Documentation and Guidelines
- Maintain a quarterly review of the Internal Guidelines (IG) to ensure content is up-to-date and appropriate. Field escalated issues from Member Specialists and Communication Specialists related to IG.
- Offer input on ideas and content provided by Communication Specialists to ensure accuracy and appropriateness. Review with ERB-S if questions arise.
- Ensure the ERB sheet is up-to-date and review case data for recurring themes. Review content entered for accuracy and completeness.
- Collaborate to determine necessary chart edits and the need for additional charts, algorithms, etc. Review information input on charts and algorithms for accuracy.
- Keep current with CHM’s Guidelines and organize staff and member input into these guidelines. Ensure the Guidelines’ tracking sheet is up to date.
Communication and Teamwork
- Identify issues within the ER-Team, CHM staff, and CHM member base, and add them to the agenda for discussion as they occur.
- Work directly with the ER-Supervisor and ER-Team to maintain and improve consistency with CHM Guidelines and communication with members and across all departments.
Additional Qualifications and Traits
- Possess an in-depth understanding of CHM’s Guidelines.
- Have a basic understanding of medical conditions and how they would be classified according to CHM’s definitions.
- Respond to all correspondence from members and the ER-Supervisor in a timely manner.
- Capable of handling phone calls, emails, messages, and projects simultaneously.
- Be adaptable and able to attend ERB meetings as needed, embracing changes and challenges.
- Work collaboratively with all departments and provide assistance when needed.
- Maintain a professional attitude at all times.
- Exercise integrity and accountability when utilizing authorities and acting in a role of approver/reviewer on internal or member transactions.
- Required: High school diploma or passage of a high school equivalency exam
- Capacity to maintain confidentiality.
- Ability to recognize, research and maintain accuracy.
- Excellent communication skills both written and verbal.
- Able to operate a PC, including working with information systems/applications.
- Previous experience with Microsoft Office programs (I.e., Outlook, Word, Excel & Access)
- Experience operating routine office equipment (i.e., faxes, copy machines, printers, multi-line telephones, etc.)
- Perform other job duties as assigned by management.
About Christian Healthcare Ministries
Founded in 1981, Christian Healthcare Ministries (CHM) is a healthcare sharing ministry for Christians. CHM is a nonprofit, voluntary cost-sharing ministry through which participating Christians meet each other’s medical bills. The mission of CHM is to glorify God, show Christian love, and experience God’s presence as Christians share each other’s medical bills.