Medicare & Medicaid Enrollment Supervisor

Immanuel • Omaha, NE

2d • Onsite

About The Position

Immanuel Pathways PACE® is seeking an Enrollment & Eligibility Supervisor to work at Immanuel Home Office located at 1044 North 115th Street, Omaha, NE 68154. This leadership role is responsible for overseeing Medicare enrollment, Medicaid eligibility, participant enrollment processes, regulatory compliance, enrollment reconciliations, and benefit administration across multiple PACE centers. The position also supervises eligibility staff, develops quality assurance processes, and partners with operational leaders to ensure enrollment accuracy and exceptional participant service.

Requirements

• Three (3) years of progressively responsible experience in Medicare, Medicaid, PACE, managed care, health plan operations, enrollment, eligibility, or revenue cycle preferred.
• Previous supervisory or leadership experience preferred.
• One (1) year of experience working with the frail or elderly population required, or completion of job specific training related to working with the elderly population must be completed within the first six months of hire.

Nice To Haves

• Bachelor’s degree in healthcare administration, business administration, finance, or a related field is preferred.
• Equivalent combination of education or years of relevant experience may substitute for education requirement.

Responsibilities

• Provide centralized oversight of PACE enrollment documentation and eligibility processes across all PACE centers.
• Establish standardized processes and controls to ensure required Medicare, Medicaid, demographic, payer, and eligibility information is accurately collected and documented prior to participant enrollment.
• Review enrollment documentation and conduct routine audits to ensure required information is complete, accurate, and consistent across enrollment paperwork and organizational systems.
• Partner with center Enrollment Coordinators, Program Relationship Managers, Executive Directors and other leaders to resolve enrollment documentation deficiencies or discrepancies.
• Ensure Medicare Beneficiary Identifier information, Medicaid identification information, Medicare entitlement status, Medicaid eligibility status, payer information, and other required enrollment information are accurately entered into applicable systems.
• Develop enrollment checklists, quality assurance processes, and standardized workflows for use across all PACE centers.
• Provide training and ongoing education to enrollment staff regarding Medicare and Medicaid documentation requirements.
• Identify trends in enrollment errors and implement process improvements to reduce recurring issues.
• Oversee monthly Medicare enrollment and disenrollment processes.
• Review CMS transaction reports, including the Daily Transaction Reply Report (DTRR), to identify enrollment changes, rejected transactions, discrepancies, or other items requiring action.
• Ensure DTRR transactions are researched, assigned, corrected, and resolved timely.
• Monitor CMS enrollment records through the Medicare Advantage and Prescription Drug System (MARx) and ensure participant enrollment information accurately reflects current status.
• Complete or oversee required MARx updates when participant circumstances or enrollment status changes.
• Reconcile internal PACE enrollment records against CMS enrollment information and investigate discrepancies.
• Maintain controls to ensure enrollment transactions are processed within required CMS timelines.
• Track enrollment-related exceptions and outstanding transactions through resolution.
• Coordinate with internal departments when Medicare enrollment discrepancies may affect participant care, pharmacy coverage, claims processing, or capitation payments.
• Manage the PACE retroactive enrollment and disenrollment process, including identification, documentation, submission, tracking, and resolution of retroactive requests.
• Review circumstances requiring retroactive enrollment or disenrollment and ensure appropriate supporting documentation is obtained.
• Maintain tracking of all retroactive requests from initiation through final determination.
• Communicate approved or denied retroactive changes to appropriate internal stakeholders.
• Coordinate with Finance, Claims, Part D, and other departments regarding the financial and operational impact of retroactive enrollment changes.
• Identify systemic causes of retroactive enrollment requests and implement corrective actions when opportunities for process improvement are identified.
• Monitor participants who are Medicaid-only at the time of PACE enrollment for subsequent Medicare entitlement or eligibility.
• Ensure Medicare entitlement information is identified and acted upon timely.
• Coordinate required communication with participants and their authorized representatives regarding Medicare entitlement.
• Prepare and distribute Medicare entitlement letters and other required participant communications within established timelines.
• Track participant response and follow-up activities associated with Medicare entitlement.
• Coordinate updates to internal enrollment systems, MARx, pharmacy/Part D systems, and other applicable systems following changes in Medicare status.
• Partner with the Eligibility Coordinator to ensure newly Medicare-entitled participants receive appropriate assistance navigating enrollment requirements.
• Provide oversight of the Eligibility Coordinator responsible for ongoing Medicaid eligibility maintenance.
• Ensure Medicaid renewals and redeterminations are identified sufficiently in advance to prevent avoidable eligibility lapses.
• Monitor participants at risk of losing Medicaid coverage and ensure appropriate intervention and escalation.
• Establish processes for tracking Medicaid renewal dates, required documentation, outstanding applications, and eligibility determinations.
• Oversee resolution of Medicaid eligibility discrepancies between state systems and organizational records.
• Monitor participant share of cost, client participation, patient liability, spend-down, or similar Medicaid financial obligations.
• Ensure changes in participant financial responsibility are communicated and coordinated appropriately with participants, representatives, Finance, and other internal departments.
• Develop escalation process for complex Medicaid eligibility cases.
• Establish and oversee monthly reconciliation processes comparing: PACE enrollment records, CMS/MARx enrollment information, Medicare entitlement information, State Medicaid eligibility information, Internal billing and financial systems, Part D enrollment information, as applicable.
• Ensure discrepancies are documented, investigated, and resolved within established timeframes.
• Develop exception reports and dashboards identifying enrollment and eligibility issues requiring intervention.
• Monitor participant eligibility and enrollment changes that could impact Medicare and Medicaid capitation.
• Partner with Finance to resolve discrepancies impacting payment.
• Assist with reconciliation of retroactive capitation adjustments associated with enrollment corrections.
• Provide direct supervision, coaching, development and performance management for the PACE Eligibility Coordinator(s) and other enrollment/eligibility staff as assigned.
• Establish clear expectations, workflows, productivity standards, and performance measures.
• Conduct routine case reviews to ensure complex eligibility issues are progressing toward resolution.
• Serve as an escalation resource for challenging Medicare, Medicaid, enrollment, or participant financial responsibility cases.
• Promote a culture of accountability in which staff own eligibility functions and enrollment issues through final resolution.
• Build strong working relationships between centralized eligibility functions and PACE center enrollment teams.
• Maintain working knowledge of CMS PACE enrollment requirements, Medicare enrollment guidance, applicable Medicaid requirements, and organizational policies.
• Ensure enrollment and eligibility processes comply with applicable regulatory and contractual requirements.
• Maintain policies, procedures, workflows, and desk-level instructions related to Medicare and Medicaid enrollment and eligibility.
• Maintain documentation necessary to demonstrate compliance during CMS, state, internal, or external audits.
• Conduct routine internal audits of participant enrollment and eligibility records.
• Develop and implement corrective action plans when deficiencies are identified.
• Monitor changes in Medicare and Medicaid requirements and coordinate operational implementation.
• Partner with Compliance, Quality, Finance, and other departments on enrollment-related regulatory matters.

Benefits

• Medical, dental, vision, Health Savings Account (HSA), and Flexible Spending Account (FSA)
• Employer Paid Life Insurance
• Paid Time Off - accruing from day one of employment, Floating Holidays, Paid Holidays, 8 hours of Volunteer Time Off per year
• 401K with employer match
• Wellness Program and Employee Assistance Program
• Advancement opportunities (as appropriate) – we look to grow from within our organization
• Education Assistance Program – we invest up to $5,250 per year for education assistance paid up front

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level