Medicare Enrollment Specialist

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Medicare Enrollment Specialist

BASIC FUNCTION

The Medicare Enrollment Specialist is responsible for ensuring that all members enrolled in Medicare plan(s) are reflected accurately. This position will serve as the subject matter expert for enrollment and disenrollment for Medicare beneficiaries on our plan, while creating an experience that exceeds expectations in every interaction. With strong communication and organizational skills, the Medicare Enrollment Analyst assists leadership and team in achieving goals, objectives, and improvements.

Reports To Applications Supervisor

GENERAL RESPONSIBILITIES

The Medicare Enrollment Specialist is accountable to provide an excellent level of service to internal as well as external customers. The Medicare Enrollment Specialist will also coordinate responsibilities with those of the Applications Supervisor to:

• Prepare, process and maintain enrollment and disenrollment requests
• Verify and maintain all applicable eligibility requirements
• Review and process CMS transactions
• Reconcile eligibility discrepancies and submit retroactive eligibility changes
• Support the overall success of achieving organization-wide goals, including but not limited to; enrollment, quality, health outcomes, and customer satisfaction
• Conduct monthly enrollment data validations (EDV's)
• Work with other departments on cross-functional tasks, projects, and follow-up
• Identify trends that may lead to policy updates or process improvements that support the superior model and/or impact quality and departmental performance standards
• Work with Enrollment Operations Team Lead to ensure departmental policies are up to date and receive appropriate committee approval
• Perform other duties as assigned

QUALIFICATIONS

• Education : A high school diploma or equivalent is required
• Work Experience : One (1) year of Medicare enrollment/Medicare Managed Care or related healthcare industry experience is preferred

• Experience with CMS system is preferred
• Possess an understanding of health care as it relates to enrollment
• Ability to understand and become knowledgeable of standards, policies and procedures, and regulations to complete work in compliance of these and other standards.

Skills/Competencies : A successful candidate for the Member Experience Advocate I will possess the following skills and/or competencies:

• Knowledge and understanding of enrollment and disenrollment processes

• Familiarity with Medical Terminology is preferred

• Basic knowledge of Medicare and/or Medicare Advantage program(s) is preferred

• Excellent oral and written communication skills
• Strong analytical skills

• Excellent organizational skills
• Computer and data entry skills are required

• Excellent time management skills
• Ability to work independently and take initiative
• Skills in MS Word, Outlook and Excel

There may be additions, deletions and modifications to the qualifications and functions of this job from time to time.

Job Types: Seasonal, Temporary

Pay: $20.00 per hour

Weekly day range:

• Monday to Friday

Work setting:

• In-person

Education:

• High school or equivalent (Preferred)

Work Location: In person