Enrollment Service Rep

Job Description

Job Description

The Medicare Enrollment Representative is responsible for timely processing of enrollment and disenrollment requests using CMS guidelines and policies. They are also responsible for timely completion of all correspondence and reporting functions associated with the Medicare Enrollment Unit and have knowledge of how the Enrollment functions affect other Plan Units and Departments. The Medicare Enrollment Representative provides Sales Support as needed during peak sales periods.

Required:

1. High School Diploma.
2. Typing and Computer Skills.
3. Good telephone and communication skills.
4. Self-starter, detail oriented, ability to prioritize and meet deadlines.
5. Maintain confidentiality.
6. Mathematical skills.
7. Good work ethic (i.e. adequate learning skills, even temperament, following instructions, retains information., works well with others).
8. Easily adapts to changes in work requirement.

Desired:

1. Familiar with Medicare Enrollment and Disenrollment processes.
2. Medical terminology.
3. Familiar with CMS Regulations and Guidelines.
4. Knowledge of CPT, ICD-9 & ICD-10 coding.

Responsibilities:

1. Communicate with current and prospective members professionally, accurately and thoroughly.
2. Answer prospective sales phone line and route calls to appropriate licensed Sales staff.
3. Records all calls accurately in the Customer Service Module or Medicare Call Log.
4. Complete a variety of enrollment and disenrollment functions.
5. Knowledge of how the Enrollment area functions affect other units and departments.
6. Assist with the completion of a variety of reports in accordance with CMS requirements and guidelines (i.e. TRR, BEQs and EDVs)
7. Process correspondence.
8. Report all suspicious issues to the Compliance Department or Departmental Manager.
9. Keep all former, current or prospective members (and other Employee’s) Protected Health Information (PHI) confidential.
10. Must be willing to work Overtime if required to meet the CMS timeliness requirements.
11. Participate in external and/or internal trainings as required.
12. Consistently display a positive attitude and acceptable attendance.
13. Assist with lobby traffic for current and prospective members with Enrollment/Disenrollment questions and concerns.

Equal Opportunity Employer

The Health Plan is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. The Health Plan strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law. The Health Plan employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation, benefits, and termination of employment.