Medicare Enrollment Specialist

WVU Medicine•Home Work - TX (Remote), TX

About The Position

The Medicare Enrollment Specialist works with the Peak Health team at WVU Medicine, supporting the enrollment team’s processing of member enrollment application information for Peak Health’s Plan Suite. Reporting to the Enrollment Manager, this role analyzes and processes enrollment forms for validity, completion, and accuracy; determines whether applications should be enrolled, sent for outreach, or rejected in accordance with organizational policies and procedures; and reviews documents for quality control before final entry. The specialist also helps maintain an effective and efficient enrollment operation and supports a seamless member experience. The role includes managing enrollment records and related member information, resolving enrollment issues, maintaining workqueues and quality standards, coordinating benefits, processing SNP applications, and supporting training, system testing, and Open Enrollment planning. It is a 40-hour-per-week, non-exempt position in a standard office environment.

Requirements

High school diploma or equivalent and two years of experience working with medical or institutional data entry and two years of customer service experience; or a high school diploma or equivalent and one year of Medicare eligibility and Medicare enrollment processing experience; or a bachelor's degree.
Familiarity with medical insurance enrollment processes.
Working knowledge of administrative and clerical procedures and systems, including word processing and managing files and records.
Ability to take direction and navigate multiple systems simultaneously.
Excellent written and oral communication, customer service, interpersonal, and telephone etiquette skills.
Ability to solve problems using predefined methods and guidelines to improve efficiency and customer satisfaction.
Exceptional attention to detail, organization, and ability to perform multiple tasks simultaneously.

Nice To Haves

Associate degree or higher in a related healthcare field.
Three to five years of Medicare enrollment processing and customer service experience.
Two years of experience with Medicare elections, transaction codes, and reconciliation operations.
Two years of experience managing late enrollment penalties (LEP) for MAPD enrollees.
Familiarity with CMS tools and resources, particularly the MARx website.
At least one year of experience with system/user acceptance testing.
At least one year of experience developing and delivering trainings.

Responsibilities

Determine whether member enrollment forms are accurate and complete; enter and verify form data.
Resolve enrollment issues to support an efficient and seamless member experience.
Maintain Medicare member enrollment records annually, recording changes and updates and completing outreach as required.
Meet production and quality standards and maintain workqueues according to department standards.
Communicate effectively with internal and external staff.
Escalate issues to the next level of supervision when appropriate.
Ensure the accuracy of entered data and maintained records.
Attend required training and demonstrate proficiency and ability to learn.
Manage coordination of benefits (COB) on member records.
Develop and deliver department training for new hires.
Participate in system testing for development rollouts.
Participate in department planning for a successful Open Enrollment.
Process SNP applications and verify eligibility, including dual entitlement and residence within the service area.
Perform other duties as deemed appropriate by the Management Team.