Enrollment Coordinator

Position Purpose: The Enrollment Specialist is responsible for performing duties related to enrollment of Medicare beneficiaries (in the Medicare Advantage Health Plans) and Medicaid beneficiaries. Knowledge of Medicare Advantage Guidelines per CMS Chapter 2, and knowledge of transactions between CMS and health plans. Excellent oral and written communication skills including good grammar, voice and diction. Able to read and interpret documents. Proficient in MS Office with basic computer and keyboarding skills. Detail oriented and highly organized. Excellent customer service skills (friendly, courteous and helpful).
Responsibilities:

• Adheres to Processing guidelines to meet Enrollment timeliness requirements as defined by CMS; Analyze the member application and accompanying documents, ensuring applicant eligibility and match to CMS's records.
• Analyze the member application and accompanying documents, ensuring applicant eligibility and match to CMS's records.
• Accomplishes daily enrollment, plan changes and disenrollment operations, including application review, entering applications into system and submissions to CMS.
• Conduct calls to beneficiaries, to request additional information to be able to process request.
• Monitors and works closely with providers to obtain confirmation of condition for members enrolled in SNP plans.
• Identify members.
• Be able to reconcile and analyze each section of Daily TRR report, including enrollments and disenrollment's, Multiple Transactions, Special Status Codes, such as ESRD, and State and County Code (SCC), Analyze and update member records. Contact members via telephone and letter to obtain information necessary to resolve discrepancies. Generate and process appropriate letters.
• Researches eligibility discrepancies and compiles and submits necessary supporting documentation to RPC for correction to CMS.
• Be able to process and maintain the Late Enrollment Process, OOA, CSNP and DSNP process.
• Review and update PCP reports, error reporting, daily processing files from CMS and other processing related tasks
• Responsible for processing of returned mail to ensure integrity of member records. Interface with departments to fulfill company and members requests and resolve member issues.
• Responsible for informing the Medicare Enrollment Manager of all unresolved issues or questions and act as facilitator to resolve them.
• Assist department with all functions on an as needed basis in regards to enrollments, disenrollment's, LEP, OOA, Enrollment and Disenrollment Monthly Matrix, CTM and RPC.
• Coordinates with Sales & Marketing department on initial application process.
• Ensure proactive customer service techniques with the highest degree of courtesy and telephone etiquette.
• Comply with all applicable Policies and Procedures.
• May be asked to lift boxes, up to 5 pounds.
• Must be able to work overtime, weekends as business necessary.
• Review and mail all letters to members in accordance with regulatory guidelines.
• Excellent communication skills, verbal and written
• Able to identify priorities, plan work schedule, meet deadlines, able to manage multiple tasks and frequent interruptions
• Reviews monthly CMS reports including: LISHIS, LIS, special TRR, Plan Payment Report, and Demographic Report. Compares reports to eligibility file and resolves any discrepancies
• Work in fulfillment center printing letters, ID Cards, and general mail processing.
• Ensures proactive customer service techniques with the highest degree of courtesy and telephone etiquette.
• Review and mails letters to members in accordance with regulatory guidelines.
• Reviews monthly CMS reports including: LISHIS, LIS, special TRR, Plan Payment Report, and Demographic Report. Compares reports to eligibility file and resolves any discrepancies.
• Comply with all applicable Policies and Procedures.
• May be asked to lift boxes, up to 5 pounds.
• Must be able to work overtime, weekends as business necessary.
• Review and mail all letters to members in accordance with regulatory guidelines.
• Excellent communication skills, verbal and written.
• Able to identify priorities, plan work schedule, meet deadlines, able to manage multiple tasks and frequent interruptions.
• Reviews monthly CMS reports including: LISHIS, LIS, special TRR, Plan Payment Report, and Demographic Report. Compares reports to eligibility file and resolves any discrepancies.
• Work in fulfillment center printing letters, ID Cards, and general mail processing.
• Performs other duties as assigned.

Individual Responsibilities:

• Must be able to prioritize work with administrative deadlines.
• Shows initiative in problem solving and be open to new idea.
• Able to work independently and in teams with close attention to detail

Qualifications:

• Bilingual (English/Spanish).
• A minimum one-year related healthcare industry including Medicare Part D experience and patient/beneficiary services.
• Understanding of healthcare terminology and definitions.Strong Verbal/Written communication skills.

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.
No Third Party Agencies or Submissions Will Be Accepted.
Our company is committed to creating a diverse environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. DFWP
Opportunities posted here do not create any implied or express employment contract between you and our company / our clients and can be changed at our discretion and / or the discretion of our clients. Any and all information may change without notice. We reserve the right to solely determine applicant suitability. By your submission you agree to all terms herein.