[Hiring] Medicaid Senior Enrollment Specialist @HealthEdge

Role Description

UST HealthProof is looking for a Senior Enrollment Specialist, reporting to the Enrollment Manager. The Senior Enrollment Specialist is responsible for ensuring accurate enrollment including billing and maintenance of member data by researching and resolving enrollment and billing discrepancies. The role is also responsible for reconciling and correcting enrollment-related issues by building case files that are sent to the CMS Contractor for approval and resolution.

• Be responsible for preparing, processing, and maintaining enrollment and disenrollment requests
• Be responsible to verify and maintain all applicable eligibility requirements
• Be responsible to review and process CMS transactions
• Be responsible to review Medicaid eligibility and complete verification processes
• Be responsible to resolve enrollment system rejections based on regulatory and client specified guidelines
• Be responsible to reconcile membership reports as required by CMS
• Be accountable to attend and successfully complete the trainings scheduled by the client and employer
• Mentor junior members of the team
• Collaborate with other team members on special projects; special projects can include process documentation development, training, quality reviews for the client(s), or any other project as determined by management
• Establish and maintain an appropriate level of communication with management to address issues and concerns and take preventive measures that ensure case accuracy and quality
• Participate in projects as assigned by management
• Perform other duties as assigned

Qualifications

• 5+ years of professional experience in processing Medicare enrollment transactions
• A thorough understanding of Medicare Advantage products, CMS transaction files, and the corresponding enrollment-related guidelines
• Experience with CMS interfaces and systems for managing the Medicare Advantage enrollment and billing functions; Medicaid knowledge is a plus.
• Ability to analyse enrollment reconciliation data and report SLAs, KPIs, and other operations reports and present findings in a structured way
• High school degree required
• Willingness to learn
• Team collaborator
• Strong work ethic

Requirements

• The ability to adapt quickly to a challenging environment
• A self-starter and quick learner
• Ability to collaborate

Work Environment

• The employee is occasionally required to move around the office.
• Specific vision abilities required by this job include close vision, color vision, peripheral vision, depth perception, and ability to adjust focus.
• Work across multiple time zones in a hybrid or remote work environment.
• Long periods of time sitting and/or standing in front of a computer using video technology.
• May require travel dependent on company needs.

Compensation

The annual US base salary range for this position is $50,000 to $56,000. This salary range may cover multiple career levels at HealthEdge. Final compensation will be determined during the interview process and is based on a combination of factors including, but not limited to, your skills, experience, qualifications and education.