CHRISTUS Health Plan is a Qualified Health Plan issuer in the Federally-facilitated Marketplace of Texas and is required to resolve HICS cases within a regulated timeframe. This job function is a front line resource to receive, triage and resolve HICS casework for CHRISTUS Health Plan in order to meet compliance guidelines associated with the Affordable Care Act.
Hours of operation will be Monday -Friday 8am to 6pm (Holidays and weekends)
Job Duties include but are not limited to the following:
Fully research and resolve urgent cases per CMS guideline in the third party government inquiry control system (HICS)
Research and or update all requests for 1095 tax data
Expert knowledge of EDI 834 files
Analyze and resolve inquiries by adhering to CMS Federally Facilitated Marketplace Guidelines
Strong Knowledge of Interpretation and Updating Enrollment Reconciliation Reports as needed
Critical Attention to Details to Identify Key Trends, Patterns etc.
Experienced communication with a diverse consumer population (including but not limited to Marketplace and CMS personnel)Utilization of various files for research and investigation
Create/Prepares appropriate resolution letters which meet regulatory requirements for content and timeliness
Level 2 casework within 15 calendar days of receipt of the case by the issuer. Level 1 casework within 3 calendar days of receipt of the case by the issuer; outbound calls to members for Level 1 cases are required.
HICS Research Advocate must expertly understand, navigate and comply with federal regulations pertaining to written notification/letters as outlined in BEIC Guidance Handbook and all SO HICS Operations SOPs/DTPs.
Select the proper static letter via client letter system or create a customized dynamic letter to address the member's complaint and provide the summary of the resolution taken
Perform other duties as assigned e.g. act as a Subject Matter Expert
Bachelor's degree from an accredited institution or equivalent experience
2 or more years' directly related work experience in Enrollment, Membership, Billing, Contract or Claims, and Eligibility.
Experience with understanding the Affordable Care Act, Qualified Health Insurance plans terminology and benefits
CHRISTUS HEALTH is an international Catholic, faith-based, not-for-profit health system comprised of almost more than 600 services and facilities, including more than 60 hospitals and long-term care facilities, 350 clinics and outpatient centers, and dozens of other health ministries and ventures. CHRISTUS operates in 6 U.S. states, Colombia, Chile and 6 states in Mexico. To support our health care ministry, CHRISTUS Health employs approximately 45,000 Associates and has more than 15,000 physicians on medical staffs who provide care and support for patients. CHRISTUS Health is listed among the top ten largest Catholic health systems in the United States.