Senior Enrollment Specialist

HealthEdge•Remote,

8d•$50,000 - $56,000•Remote

About The Position

HealthEdge® offers AI-powered operational infrastructure for health insurance companies, guaranteeing an enduring financial edge in an increasingly competitive market. We're experiencing strong market momentum, with a growing number of health plans choosing HealthEdge to modernize their operations and compete more effectively. As we expand, we're investing in the people who power that growth, making this a pivotal moment to join us and shape the future of healthcare technology. Learn more at HealthEdge.com. At UST HealthProof, you will join a fast paced, growing company in our mission to reshape the future of health insurance through significantly reducing administrative costs and building better healthcare experiences for our health plans customers and their members. By creating a modern, cloud based, Best-In-Class core administration ecosystem, we have made healthcare more affordable and helped our health plans operate more efficiently. Through member and provider touchpoints with less friction, we have created real impact for members. UST HealthProof is run by leaders with strong health plan and technology backgrounds who have start-up mindsets and an environment of support where individual growth is nurtured. You will be supporting our proven core admin solutions and business process-as-a-service (BPaaS) operations to provide transparency, improve operational efficiency, and break down operational barriers to scale and drive strategic growth. UST HealthProof is looking for a Senior Enrollment Specialist, reporting to the Enrollment Manager. The Senior Enrollment Specialist 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.

Requirements

5+ years of 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 analyse enrollment reconciliation data and report SLAs, KPIs, and other operations reports and present findings in a structured way
High school degree required
Willingness to learn
Team collaborator
Strong work ethic

Nice To Haves

Medicaid knowledge is a plus
The ability to adapt quickly to a challenging environment
A self-starter and quick learner
Ability to collaborate

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 the trainings scheduled by the client and employer
Mentoring junior members of the team
Collaborating 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
Establishing and maintaining an appropriate level of communication with management to address issues and concerns and take preventive measures that ensure case accuracy and quality
Participating in projects as assigned by management
Performing other duties as assigned