Ensure timely and accurate processing of enrollment applications, disenrollments, cancellations, and eligibility changes. Ensure all CMS required materials are mailed within the CMS required timeframes.
Process daily Transaction Reply Reports from CMS. Assist members / providers and internal customers by responding to and resolving all inquiries related to the enrollment / disenrollment process.
Process daily, weekly and monthly reconciliation reports. Assist with day-to-day operations of the Enrollment Team while ensuring that compliance standards are met.
Identify and analyze system problems and provide proposed solutions and / or recommendations as they relate to the enrollment process.
Complete and track any special projects or reconciliations pertaining to the enrollment process, as well as, conducting root cause analysis and remediation for any and all enrollment escalations (i.e. CTM Complaints, Appeals, and Grievances, etc.). Any and all other responsibilities as delegated.
Skills :
3 to 5 years, Enrollment Experience Preferred Microsoft Office- Excel, Access, Word, Outlook Knowledge of Medicare regulations, experience in Managed Care Enrollment (MA, MAPD and PDP), Knowledge of CMS.
Knowledge of BAE, LEP and LIS.
Knowledge of MMP Plans.
Demonstrated ability to perform highly advanced billing / enrollment research, and skills in problem identification and resolution required.
Demonstrated ability to achieve high accuracy in work.
Experience in a quality assurance role and quality monitoring, preferably in an enrollment operations environment.
Understanding of standard quality procedures.
Experience with developing or maintaining policies and procedures documentation.
Reporting experience, including report development and quality reporting.
Excellent organizational, written, and verbal communication skills.
Demonstrated ability to exercise good judgment, initiative and tact in discussing employee performance results.
Demonstrated professionalism when dealing with conflict, changing work environment and multiple priorities.
Ability to perform comfortably in a fast-paced, deadline-oriented work environment.
Supports an environment that fosters teamwork, cooperation, respect and diversity. Ability to work as a team member, as well as independently.
Manage the data integrity of enrollment records and remittance files transmitted from the state. Handles complaints regarding eligibility and enrollment.
Monitors complex enrollment issues due to the process and recommends improvements to reduce errors.
Responsible for the effective development, coordination and presentation of training and development programs for all Med D Enrollment employees.
Actively search, creatively design and implement effective methods to educate, enhance performance and recognize performance.
Demonstrates and supports commitment to corporate goals and mission.
Performs other related duties as assigned to meet overall departmental and Plan goals.
Keywords :
Education : High School / GED.
Skills and Experience :
Required Skills :
DATA INTEGRITY.
PROCESSOR.
MEDICARE.
BAE.
BILLING.
Additional Skills :
MICROSOFT OFFICE.
REMEDIATION.
CONTENT MANAGEMENT SYSTEM.
RECONCILIATIONS.
CMS.
REMITTANCE.
MANAGED CARE.
QUALITY ASSURANCE.
OPERATIONS.
HIGH ACCURACY.
EXCEL.
RECONCILIATION.
DOCUMENTATION.
Languages :
English.
Read.
Write.
Speak.
Minimum Degree Required : Completed High School (Diploma or GED).
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