Medicare Enrollment Specialist II

HealthEdge•Remote,

8d•$19 - $21•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. As an Enrollment Specialist II at HealthProof, this is your opportunity to: Be responsible for preparing, processing, and maintaining enrollment and disenrollment requests Be responsible to verify and maintain all applicable eligibility requirements Be responsible to review and process CMS transactions Be responsible for reviewing Medicaid eligibility and completing verification processes Be responsible to resolve enrollment system rejections based on regulatory and client specified guidelines Be responsible to reconcile membership reports as required by CMS Be accountable to attend and successfully complete the trainings scheduled by the client and employer Mentor junior members of the team Collaborate 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 Establish and maintain an appropriate level of communication with management to address issues and concerns and take preventive measures that ensure case accuracy and quality Participate in projects as assigned by management Perform other duties as assigned

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 (e.g., process documentation development, training, quality reviews)
Establishing and maintaining communication with management to address issues and concerns and take preventive measures
Participating in projects as assigned by management
Performing other duties as assigned