Responsibilities
Review and submit enrollment request received as well as maintaining accuracy and timeliness of acknowledgment to members
Resolve member issues and sustain quality member care
Audits data entered into the internal systems to ensure data integrity and quality
Analyzes and interprets out of area indicator reports submitted by CMS and determine action to be taken
Identify trends and risks
Stay up to date on all CMS Enrollment Regulations
Ensure quality and compliance to meet applicable guidelines
Ensure timely, accurate and complete submissions to CMS
Review prospective enrollees are appropriately screened to meet eligibility requirements within regulatory guidelines and timelines
Required member mailings are sent timely and within regulatory guidelines
Responsible for ensuring the completeness, quality and eligibility criteria of member’s application to meet Enrollment Requirements.
Ensure all completed applications are submitted within required time frames.
Utilizes various computer systems and applications to perform daily functions.
Understands the BEQ and TRR processes
Requirements And Skills
High School Diploma
Two Years Of Medicare Advantage Experience Required
Knowledge of health plan benefits, processes and Operations
Prior experience with Commercial and Medicare Advantage Plans
Attention to detail and problem solving
Excellent communication skills
TPA Experience Preferred
Work weekends and company holidays as needed based on business needs
Detailed Oriented with the ability to conduct research and identify steps to resolve issues to completion
Ability to meet Enrollment timelines.
Ability to assume responsibility and exercise good judgment when making decisions within the scope of the position
Job Type: Full-time
Pay: $22.00 – $30.00 per hour
Expected hours: 40 per week
Benefits
Dental insurance
Health insurance
Paid time off
Vision insurance
Experience
Processing Medicare Enrollments: 2 years (Required)
Work Location: Remote