Medicare Member Enrollment Specialist - 100% remote

Ram Technologies•Philadelphia, PA

10d•$17 - $20•Remote

About The Position

At RAM Health, the mission is to simplify healthcare administration through innovative, technology-driven solutions that help government-sponsored health plans improve performance and quality while reducing costs. The Medicare Member Enrollment Specialist processes enrollment transactions and member data using documented business rules and processes, CMS guidance, and client rules. The position is 100% remote and requires analytical ability, attention to detail, and strong written and oral communication skills. The specialist processes Medicare Advantage enrollment and member-maintenance transactions, performs reconciliations, captures Coordination of Benefits data, and generates required member correspondence. The role also involves meeting production and quality standards, identifying process-efficiency opportunities, and completing special projects. Employees must follow company security and privacy policies and applicable laws and regulations, including HIPAA and HITECH, and safeguard protected health information and personally identifiable information.

Requirements

1–3 years of healthcare industry experience in Medicare Advantage, Managed Medicaid, or with an industry competitor processing enrollment applications and member status changes.
Experience working with the CMS Medicare Advantage & Prescription Drug System (MARx).
Experience in a Business Process as a Service (BPaaS) setting or similar environment.
Experience working in a production environment and ability to meet performance standards.
Attention to detail and ability to apply documented procedures to achieve desired outcomes.
Proficiency with MS Word and MS Excel.
Good interpersonal skills and strong written and oral communication abilities.
High school diploma required.

Nice To Haves

Familiarity with the Medicare Advantage and Part D Enrollment and Disenrollment Guidance (formerly Chapters 2 & 3).
Familiarity with the CMS Plan Communications User Guide (PCUG).

Responsibilities

Process Medicare Advantage member record updates, including enrollment applications, disenrollment requests, address changes, ACH updates, and demographic updates.
Process transactions requiring manual intervention from CMS files and reconciliation reports.
Generate CMS-required correspondence for members or at their request.
Perform monthly reconciliation of member enrollment data against the CMS system of record.
Accurately enter member Coordination of Benefits (COB) data.
Meet established production and quality standards.
Identify opportunities to improve efficiency within assigned processes.
Complete special projects as assigned.
Comply with company security and privacy policies and applicable laws and regulations, including HIPAA and HITECH.
Safeguard protected health information (PHI) and personally identifiable information (PII), ensuring data is accessed, processed, stored, and transmitted securely.