[Hiring] Medicare Enrollment Specialist @WVU Medicine

Role Description

Come join our Peak Health team at WVU Medicine as a Medicare Enrollment Specialist, contributing to the foundation for an innovative, new health plan. This position will report to the Enrollment Manager, playing a unique and important role in our mission to change healthcare for the better.

• Analyze and process enrollment forms, checking for validity, completion, and accuracy.
• Determine whether to enroll, outreach, or reject applications while following organizational policies and procedures.
• Review and evaluate all documents for quality control for final entry of member enrollment forms.

Qualifications

• High School diploma or equivalent.
• Two (2) years of experience working with medical or institutional data entry.
• Two (2) years of customer service experience.
• OR one (1) year of Medicare eligibility and Medicare Enrollment processing experience.

Requirements

• Associate Degree, or greater, in related healthcare field (preferred).
• Three (3) to five (5) years of Medicare Enrollment processing and customer service experience (preferred).
• Two (2) years of experience with Medicare elections, transaction codes, and reconciliation operations (preferred).
• Two (2) years managing late enrollment penalty (LEP) for MAPD enrollees (preferred).
• Familiarity with navigating CMS tools and resources, particularly the MARx website (preferred).
• At least one (1) year of experience with system/user acceptance testing (preferred).
• At least one (1) year of experience with developing and delivering trainings (preferred).

Core Duties and Responsibilities

• Determine accuracy and completions of member form information. Entry/verifies form data.
• Resolve enrollment issues to assure efficient and seamless member experience.
• Maintain Medicare member enrollment records annually, indicating changes, updates, and outreach as required.
• Meet all production and quality standards, maintaining Workqueues according to department standards.
• Effectively communicate with internal and external staff.
• Elevate issues to next level of supervision, as appropriate.
• Ensure accuracy of data entered and record maintenance.
• Attend all required training classes, demonstrating proficiency and ability to learn.
• Manage coordination of benefits (COB) on member records.
• Develop and deliver department trainings to new hires.
• Participate in system testing for any development rollouts.
• Participate in department planning to ensure a successful Open Enrollment.
• Process SNP applications, verifying eligibility, including but not limited to Dual-Entitlement and residence within the service area.

Physical Requirements

• Ability to sit for extended periods of time.

Working Environment

• Standard office environment with electrical equipment (i.e., telephone, personal computer, copier, fax machines, etc.).
• Computer Software/Systems include but not limited to Microsoft Office Professional Suite (Outlook, Word, Excel, Access), Internet Explorer, and EPIC.

Skills and Abilities

• Familiarity with Medical insurance enrollment processes.
• Working knowledge of administrative and clerical procedures and systems such as word processing and managing files and records.
• Ability to take direction and to navigate through multiple systems simultaneously.
• Excellent written and oral communication, customer service, interpersonal skills, and telephone etiquette skills.
• Ability to solve problems with predefined methods and guidelines to drive improved efficiencies and customer satisfaction.
• Requires exceptional attention to detail, the ability to be organized and to be able to perform multiple tasks simultaneously.