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Enrollment Specialist

Kavaliro Orlando, FL

  • Expired: over a month ago. Applications are no longer accepted.
Job Description

Summary/Objective

The Enrollment Specialist is responsible for Enrollment of Medicare beneficiaries, prepares, processes and maintains new member applications, re-enrolls, dis-enrolls, LEP and plan changes or group enrollments and eligibility calculations as stipulated in the CMS guidelines including a variety of clerical duties involving typing, filing, records and reports maintenance; researching, documenting, evaluating, and executing all requested member enrollment transactions. Maintains strict member and company policy confidentiality.

Essential Functions

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as required for company and/or company clients, customers, and affiliates.

  • Data Enters applications, cancellations and disenrollment
  • Process, notifies and reports Medicare enrollment Manager Rejections, cancellations, and possible CMS rejections.
  • Performs the daily and monthly TRR and coordinates with Analyst and Manager.
  • Responsible for LEP processing, calculations and maintains hours and contributions in database on a monthly basis for eligibility calculations for reporting to insurance carriers for benefits.
  • Responsible for reconciling, maintaining and tracking all new application in the receiving log and doing a reconciliation audit of all received appls versus appls in Log for processing. Send daily report to enrollment manager.
  • Receives, stamps, and logs all correspondence received in the team in a timely and accurate manner according to CMS regulations and company's policy and procedures.
  • Researches all Enrollment Elections Forms for completeness using all CMS regulations and time frames. Identifies and process all incomplete and complete enrollment elections in compliance with CMS regulations.
  • Acts as liaison between enrollment and sales by filling the application issue log and reconciles documents and attachments in Enrollment log, against marketing submissions.
  • Evaluate prospective members for Medicaid eligibility as needed. Monitor and process Medicaid recertification for current enrollees.
  • Responds to member eligibility or group questions and verifies enrollment status. Answers telephones and transfers to appropriate staff member.
  • Updates demographic data, benefits and other fields in the Enrollment systems based on reports or other documents received and assigned by the Leadership direction.
  • Process report to compare Enrollment system data against Claims system data
  • Process the county mismatches report and provide outcome to management
  • Perform daily audit of scrubbing, data entry, and receiving processes.
  • Works monthly reconciliation reports assigned by Leadership directions.
  • Operates computers programmed with Enrollment software to record, store and analyze information.
  • Plans and carries out recurring work using established procedures, conferring with the supervisor or higher-level specialists as necessary on technical problems.
  • Reviews member document, verifies information and prepare forms for data entry for outsourcing team, audit the work by outsource team and provide feedback to send clean enrollment transaction to CMS.
  • Prepares, processes and maintains new member or group enrollments and eligibility calculations.
  • Performs scanning and indexing in an accurate and timely manner of all forms in Enrollment system. Performs indexing of enrollment applications timely and effectively by signature date.

Desired Competencies

  • MS Office experience
  • Medicare/ Medicaid Member Enrollment experience
  • ADOBE and Microsoft proficiency with strong practical Excel experience
  • CMS regulation knowledge
  • Customer Service experience
  • Ethical Conduct
  • Thoroughness, attention to detail

Supervisory Responsibility

This position has no supervisory responsibilities.

Work Environment

This job operates in a clerical, office setting. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

This is a largely sedentary role; however, some filing is required. This would require the ability to lift files, open filing cabinets and bend or stand on a stool as necessary.

Position Type and Expected Hours of Work

This is a full-time position. Typical days and hours of work are Monday through Friday, 8:00 a.m. to 5 p.m.

Travel

  • No travel is expected for this position.

Required Education and Experience

  • High school diploma or equivalent plus two to three years’ previous experience highly desired.
  • Must type at least 40 words per minute
  • Previous experience in Managed Care and Medicare preferred

Preferred Education and Experience

  • Two to three years Medicare Enrollment Experience.

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

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