Medicare Enrollment Specialist II
HealthEdge•Remote,
•$40,000 - $44,000•Remote
About The Position
HealthProof is looking for an Enrollment Specialist II, reporting to the Enrollment Manager. The Enrollment Specialist II is responsible for ensuring accurate enrollment including billing and maintenance of member data by researching and resolving enrollment and billing discrepancies. The role is also responsible for reconciling and correcting enrollment-related issues by building case files that are sent to the CMS Contractor for approval and resolution.
Requirements
- High school diploma or GED required
- 2 years professional experience in processing Medicare enrollment transactions
- A thorough understanding of Medicare Advantage products, CMS transaction files, and the corresponding enrollment-related guidelines
- Experience with CMS interfaces and systems for managing the Medicare Advantage enrollment and billing functions
- Ability to analyze enrollment reconciliation data and report SLAs, KPIs, and other operations reports and present findings in a structured way
- Willingness to learn
- Team collaborator
- Strong work ethic
Nice To Haves
- Medicaid enrollment experience a plus
Responsibilities
- Preparing, processing, and maintaining enrollment and disenrollment requests
- Verifying and maintaining all applicable eligibility requirements
- Reviewing and processing CMS transactions
- Reviewing Medicaid eligibility and completing verification processes
- Resolving enrollment system rejections based on regulatory and client specified guidelines
- Reconciling membership reports as required by CMS
- Attending and successfully completing trainings scheduled by the client and employer
- Mentoring junior members of the team
- Collaborating with other team members on special projects; special projects can include process documentation development, training, quality reviews for the client(s), or any other project as determined by management
- Establishing and maintaining an appropriate level of communication with management to address issues and concerns and take preventive measures that ensure case accuracy and quality
- Participating in projects as assigned by management
- Performing other duties as assigned
Benefits
- Health insurance
- Dental insurance
- Vision insurance
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
