Enrollment Specialist

Description

Humana/iCare is seeking an Enrollment Specialist who will support the iCare enrollment processing duties for all lines of business including Medicare, Medicaid, Family Care Partnership (FCP) and BadgerCare Plus.

Responsibilities

The Enrollment Specialist is responsible for Humana/iCare enrollment processing activities, the preparation, distribution, and maintenance of reports including meeting various reporting requirements, and the resolution of enrollment/disenrollment issues. Other functions include maintenance of the iCare eligibility information for members, including coordination of benefits (COB), oversight of the systematic transmission of member specific enrollment files to and from the appropriate iCare vendors, oversight of the iCare enrollment mailbox, and the review of encounter errors. 

Essential Duties and Responsibilities:

• Enters iCare Medicare enrollment form information into ACT and interacts with iCare’s Sales staff as needed on specific enrollment related situations.
• Processes the iCare Medicare enrollment applications and forwards the iCare Medicare enrollments to Cognizant BMS Enrollment via ticketing system.
• Downloads and reconciles CMS TRR; approves appropriate changes in the enrollment ODS database.
• Reconciles 834 information for Medicaid and BadgerCare Plus; approves appropriate changes in the enrollment ODS database.
• Enter FCP enrollments into the enrollment ODS database and interact with iCare FCP staff members, the Wisconsin Department of Health Services (DHS), Centers for Medicare and Medicaid (CMS) and other external resource centers as needed.
• Monitors the reporting requirements for Medicare and Medicaid enrollments and disenrollments to confirm they are met.
• Resolves encounter errors given to them by the Finance Department.
• Monitors enrollment department mailbox to process demographic updates, as well as handle any enrollment related inquiries.
• Coordinate and perform COB validations, including daily inquiries from various iCare departments, as well as monthly files received from DHS/CMS and the external COB vendor. 
• Update ODS accordingly and ensure QNXT is properly updated as well.

Required Qualifications:

• Two (2) or more years’ experience in the medical insurance, Medicare and/or Medicaid environment working with eligibility/enrollment information.
• Knowledge of Medicare CMS eligibility information systems and/or Medicaid portals and in depth understanding of Medicare and/or Medicaid eligibility terms and processes.
• Experience analyzing reports to assess data trends and processing reports timely and accurately.
• Hands-on PC experience to include experience in data entry, word processing and spreadsheet applications. Demonstrated use of Microsoft Office applications including Excel, Word and Outlook.

Preferred Qualifications

• Experience working with Wisconsin Medicaid

Additional Information:

• Workstyle: Home. Home workstyle is defined as remote but will use Humana office space on an as needed basis for collaboration and other face-to-face needs.
• Typical Work Hours/Days: Monday through Friday; 8:30am - 5:00 pm (CST)

WAH Internet

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Modern Hire

As part of our hiring process for this opportunity, we will be using an interviewing technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

SSN Alert

Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application on Humana’s secure website.

Nationwide Remote - This is a remote nationwide position.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay decisions will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

 

$34,500 - $47,400 per year

 

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.