Enrollment Coordinator

Job Description

Job Description

Description:

Verda Healthcare, Inc . is a Medicare Advantage Prescriptions Drug Plan (MAPD) organization committed to the idea that healthcare should be easily and equitably accessed by all, currently available in Texas and Arizona. Our mission is to ensure that underserved communities have access to health and wellness services, and receive the support needed to live a healthy life that is free of worry and full of joy. We are looking for an Enrollment Coordinator to join our growing company with many internal opportunities.

Are you ready to join a company that is changing the face of health care across the nation? Verda Healthcare, Inc is looking for people like you who value excellence, integrity, caring and innovation. As an employee, you’ll join a team dedicated to improving the lives of our Medicare members. Our vision incorporates value-based health care that works. We value diversity.

This position reports to the Director of Enrollment.

Position Overview
The Enrollment Coordinator supports the day-to-day operations of the Medicare Advantage Prescription Drug (MAPD) enrollment function by coordinating enrollment and disenrollment activities, processing applications, maintaining accurate membership records, monitoring transaction status, and facilitating timely communication with internal departments and external vendors. The position ensures assigned tasks are completed in accordance with CMS requirements, applicable state and federal regulations, health plan policies, and established departmental procedures.

Job Description  

· Review member demographic, eligibility, contract, plan benefit package (PBP), and effective-date information for accuracy.

· Update enrollment records in designated systems in accordance with approved procedures and authorization requirements.

· Coordinate the timely distribution of accurate eligibility information to internal departments, contracted vendors, and other authorized recipients.

· Assist with identifying and routing discrepancies between internal membership systems and external eligibility records.

· Receive, review, and process Medicare enrollment and disenrollment applications for completeness, accuracy, and required supporting documentation.

· Identify missing, incomplete, or inconsistent information and coordinate follow-up to obtain corrections or clarification.

· Track application status and follow up on pending transactions to support timely processing.

· Maintain organized records of enrollment activity and supporting documentation.

· Assist with preparation, timely processing of enrollment applications, management, and maintenance in accordance with CMS regulations.

· Ensures compliance with all applicable policies, processes, and procedures.

· Support enrollment activities and reconciliation. 

· Monitor enrollment and disenrollment transactions submitted to CMS and track acknowledgments, confirmations, rejections, and pending statuses.

· Coordinate with the Enrollment Analyst or Supervisor regarding rejected transactions, unresolved discrepancies, or issues requiring further investigation.

· Monitor applicable correspondence deadlines and maintain documentation of mailing activity.

· Assist with tracking required notices and follow-up communications in accordance with approved CMS-compliant procedures.

· Escalate overdue correspondence, missing documentation, or potential compliance concerns to the appropriate supervisor.

· Report potential processing errors, missed deadlines, inaccurate eligibility information, or compliance concerns to the appropriate supervisor.

· Participate in departmental training, process updates, quality reviews, and audit preparation activities.

Professional Competencies

· Integrity and Trust

· Customer Focus

· Functional/Technical Skills

· Written/Oral Communications

· Critical/Analytical Thinker

Verda cares deeply about the future, growth, and well-being of its employees. Join our team today!

Job Type: Full-time

Comp Range : $21-26/hr

Benefits:

• 401(k)
• Paid time off (vacation, holiday, sick leave)
• Health insurance 
• Dental Insurance
• Vision insurance 
• Life insurance

Schedule:

• Full-time onsite (100% in-office)
• Hours of operations: 9am – 6pm
• Standard business hours Monday to Friday/weekends as needed
• Occasional travel may be required for meetings and training sessions.

Ability to commute/relocate:

• Reliably commute or planning to relocate before starting work (Required)

PHYSICAL DEMANDS

Regularly sit/walk at a workstation in an office or cubicle setting. Must occasionally lift and/or move up to 25-50 pounds.

* Other duties may be assigned in support of departmental goals.

Minimum Qualifications

· High school diploma or equivalent required; additional education or relevant healthcare administration training preferred.

· At least 1 year of health plan experience setting with demonstrated experience on the following list of stated knowledge, experience and/or skills.

· Proficient with Microsoft Office applications, including Word, Excel, Outlook and various database applications.

· Detail oriented with problem-solving abilities. Strong and effective verbal and written communication skills to multi-level audiences.

· Exemplary interpersonal and customer service skills. Demonstrates professionalism, poise, tact, and diplomacy in interactions with others.

· Demonstrates good judgment, organization and prioritization skills and time management skills.