• Handles receiving, controlling, and processing enrollment and disenrollment elections from Medicare beneficiaries, as well as any required updates to a member record.
• Audits data entered into the plans internal systems to ensure data integrity and quality.
• Uses judgment and informed decision-making to determine appropriate actions on elections and in handling discrepancies.
• Transmits election information to CMS within specified timeframes and according to CMS regulations.
• Ensures appropriate letters are sent to members within CMS timeframes.
• Conducts outbound calls to confirm and verify mailing addresses, permanent residency.
• Sorts returned mail and prepares mail with corrected addresses.
• Analyzes and interprets out of area indicator reports submitted by CMS and determine action to be taken.
• Place materials into storage receptacles, such as file cabinets, boxes, bins, or drawers, according to classification and identification information.
• Reads and scans all incoming materials to determine how and where they should be classified or filed.
• Sort or classifies information according to guidelines, such as content, purpose, user criteria, or chronological, alphabetical, or numerical order.
• Eliminates outdated or unnecessary materials, destroying them or transferring them to inactive storage, according to file maintenance guidelines or legal requirements.
• Performs periodic inspections of materials or files to ensure correct placement, legibility, and proper condition.
• Input data, such as file numbers, new or updated information, or document information codes into computer systems to support document and information retrieval.
• Complies with company policies and procedures and maintains confidentiality of customer medical records in accordance with state and federal laws.
• Ensures compliance with all HIPAA, OSHA, and other federal, state, and local regulations.

QUALIFICATIONS & EDUCATION

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• High school graduate or equivalent and one (1) year Medicare, Medicaid, managed care or other health/insurance related experience; or equivalent combination of education and experience.
• Data entry skills a must.
• Excellent organizational skills, customer services skills, listening, interpersonal, verbal and written communication skills with individuals at all levels of the organization.
• Excellent computer knowledge is required, including proficient knowledge of Microsoft Office.
• Familiarity with healthcare laws, regulations, and standards.
• Working knowledge of the Privacy and Security Health Insurance Portability and Accountability Act (HIPAA) regulations.
• Ability to continually display a positive attitude and follow directions.
• Ability to multitask, prioritize, carry out tasks thoroughly, and meet deadlines.
• Must be patient dealing with an elderly population and sympathetic to hearing or vision deficiencies.
• Ability to read, analyze, and interpret technical procedures or governmental regulations.
• Ability to write reports, business correspondence, and procedure manuals.
• Ability to effectively present information and respond to questions from group of managers, clients, customers and the general public.
• Ability to calculate figures and amounts, such as discounts, interest, commissions, proportions, percentages area and volume.
• Ability to define problems, collect data, establish facts, and draw valid conclusions.
• Must be able to work in a fast paced environment.
• Fluency in Spanish and English required.

What set us apart: