Medicare Member Enrollment Specialist

Ram Technologies

12d•Remote

About The Position

The Enrollment Specialist will be required to perform reviews and process various enrollment transactions including enrollment applications, Daily Transaction Reply Reporting, member maintenance, monthly reconciliation and capturing member COB data by utilizing documented business rules and processes while adhering to Center for Medicare Services (CMS) guidance and Client rules. The specialist must have excellent analytical skills, along with keen attention to detail and good written and oral communication abilities. This is a 100% remote position.

Requirements

1-3 years in healthcare industry experience working in Medicare Advantage, Managed Medicaid, or working with an industry competitor processing enrollment applications and member status changes.
Experience working with the Center for Medicare Services’ (CMS’s) Medicare Advantage & Prescription Drug System (MARx).
Experience in a Business Process as a Service (BPaaS) setting or similar environment.
Candidate should have experience working in a production environment and the ability to meet performance standards.
Attention to detail and the ability to apply documented procedures to achieve desired outcomes are also required.
MS Word and MS Excel, good interpersonal skills, written and oral communication abilities a must.
A High School Diploma is required.
Compliance: All employees shall comply with company policies, including those related to security and privacy, as well as with applicable laws and regulations such as the Health Insurance Portability and Accountability Act (HIPAA), the Health Information Technology for Economic and Clinical Health (HITECH) Act, and other relevant federal and state regulations.
Data Protection: Employees are responsible for safeguarding protected health information (PHI) and personally identifiable information (PII) in accordance with company policies and HIPAA regulations. This includes ensuring that all data is accessed, processed, stored, and transmitted securely.

Nice To Haves

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

Responsibilities

Perform tasks associated with Medicare Advantage member record updates including, but not limited to, processing enrollment applications, disenrollments requests, address changes, ACH updates, member demographic updates and others as needed.
Process transactions requiring manual intervention from various sources of CMS files and reconciliation reporting.
Generate CMS required correspondence to a member or upon the member's request.
Perform the monthly reconciliation of the member enrollment data to 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.