Enrollment Project Coordinator

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.

The Membership Project Coordinator supports various functions of the Membership Unit. Ensures that the staff has the necessary resources to perform their day-to-day activities. Coordinates and implements CMS communication projects with responsibilities that include Late Enrollment Penalty (LEP), Best Available Evidence (BAE) and Part D guidance. Organizes the preparation of assigned projects and provides the Membership Unit Director with strategic methods to implement such tasks or projects.

General Duties/Responsibilities

• Interprets and completes all guidelines as related to BAE, LEP and Part D requirements as they pertain to the Membership Unit.
• Collaborates with the PBM on the monthly LIS reimbursement’s and recoupment’s (negative balance) to ensure proper payment to the member and plan.
• Revises or creates any Policy & Procedure that pertains to applicable assignments.
• Responsible for the monthly uploaded and downloads to Acumen. (LIS & BAE)
• Ensures LEP processes are in place and well as working the monthly, weekly and daily reports.
• Maintains files and members correspondence for a monthly internal audit purpose.
• Collaborates with I.T. on all CMS updates.
• Assists in preparation of all department mailings.
• Assists with enrollment process when needed.
• Ensures that all systems are in place when there are CMS software updates or changes
• Assists Membership Director with any special project or task as assigned.
  
  

Experience

Job Requirements:

• Required: Minimum 3 years direct customer service experience. Minimum 1 year direct sales or related experience
• Preferred: Experience in Healthcare, Insurance or the Managed Care industry.
  
  

Education

• Required: High School Diploma or GED.
• Preferred: Bachelor's degree.
  
  

Training

• Required:
• Preferred:
  
  

Specialized Skills

• Required:
• Basic knowledge of Medi-Cal and Medicare Advantage Prescription Drug Plans. And MARX
• Basic Computer Skills, 40 WPM (Microsoft Outlook, excel, word)
• 10-Key by Touch
• Direct handling and processing of CMS enrollments and disenrollment applications.
• Must be familiar with CMS MMR and TRR files
• Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others.
• Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors;
• Language Skills: Ability to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals. Ability to write routine reports and correspondence.
• Mathematical Skills: Ability to add and subtract two-digit numbers and to multiply and divide with 10’s and 100’s. Ability to perform these operations using units of American money and weight measurement, volume, and distance.
• Reasoning Skills: Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions.
• Preferred: Bilingual (English/Spanish).
  
  

Licensure

• Required: None
  
  

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Essential Physical Functions

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. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear.
• The employee is frequently required to walk; stand; reach with hands and arms.
• The employee is occasionally required to climb or balance and stoop, kneel, crouch, or crawl.
• The employee must occasionally lift and/or move up to 25 pounds.
• Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.
  
  

Pay Range: $41,600.00 - $57,600.00

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

• DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email careers@ahcusa.com.