Enrollment Coordinator

Job Description

Job Description

Position Purpose:  The Enrollment Specialist is responsible for performing duties related to enrollment of Medicare beneficiaries. These duties include, but are not limited to: processing enrollment applications, working service requests received from members regarding demographic changes and other member requests, tracking letters generated and sent to members, etc.  Excellent customer service skills (friendly, courteous and helpful).

Responsibilities:

• Understands CMS Enrollment and Disenrollment Guidelines
• Analyze the member application and accompanying documents, ensuring applicant eligibility
• Accomplishes daily enrollment, plan changes and disenrollment operations, including application review and processing applications into system.
• Adheres to processing guidelines and timeliness requirements as defined by CMS
• When necessary, conducts outbound calls to beneficiaries in order to request missing information for enrollment applications
• Monitors and works closely with providers to obtain confirmation of condition for members enrolled in Chronic Special Needs plans
• Review and update PCP reports, error reporting, daily processing files from CMS and other process related tasks
• Responsible for the processing of returned mail to ensure integrity of member records
• Review and mail all letters to members in accordance with regulatory guidelines
• Assist department with all functions on an as needed basis in regards to enrollments, disenrollments, LEP, OOA, Enrollment and Disenrollment Monthly Matrix, CTM and RPC cases
• Comply with all applicable Policies and Procedures

Individual Responsibilities:

• Must be able to prioritize work with administrative deadlines
• Show initiative in problem solving
• Able to work independently as well as in a team
• Be reliable in attendance and give ample notice for absences
• Work with a positive attitude

Qualifications:

• A minimum one-year related healthcare experience including Medicare Part D and patient/beneficiary services
• Understanding of healthcare terminology and definitions
• Excellent oral and written communication skills; including good grammar, voice and diction
• Bilingual (English/Spanish)
• Proficient in MS Office with basic computer and keyboarding skills
• Detail oriented and highly organized
• Must be able to work overtime and/or weekends depending on business needs

Note:  This description indicates, in general terms, the type and level of work performed and responsibilities held by the team member(s).  Duties described are not to be interpreted as being all-inclusive or specific to any individual team member.   

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