What are the responsibilities and job description for the Medicare Enrollment Specialist position at Mphasis Digital Risk?
Enrollment Specialist
Summary: Under the supervision of the Enrollment Supervisor, the Enrollment Specialist is responsible for coordinating the enrollment process for all clients.
Essential Functions:
Enter enrollees into system monthly
Submit Enrollment Files to CMS monthly
Place enrollment file on FTP site monthly
Check DTRR reports daily
Follow-up on any issues appearing on the DTRR
Place MMR in Excel on FTP site
Submit MMRs, HCC MORs & Rx HCC MORs to PDAC monthly
Submit retroactive adjustments to Reed & Associates or CMS regional office as needed
Submit attestation information to clients monthly
Completes Enrollment Data Validation (EDV) Audits
Follow up on enrollment issues
Communicate any outstanding enrollment issues to clients
Review the A/R aging each week
Coordinate follow-up with the Accounting department for any A/R balances
Additional Functions:
Assists with special projects, as requested
Communicates clearly and concisely, with sensitivity to the needs of others
Maintains the confidentiality of all company procedures, results, and information about participants, clients, providers and employees
Maintains courteous, helpful and professional behavior on the job; displays a willingness and ability to be responsive in a warm and caring manner to all customer groups. Consistently cooperates and supports organization in problem solving issues.
Establishes and maintains effective working relationships with co-workers
Follows all Policies and Procedures and HIPAA regulations
Participates in any recommended or required training sessions
Maintains a safe working environment
Supervisory Responsibility: None
Travel: No travel is anticipated for this position
Knowledge, Skills and Abilities:
Educational requirements include a high school diploma or equivalent.
Three years of experience in a health plan management or insurance company, or similar experience, is required. Prior experience working with enrollments is strongly preferred. A working knowledge of Medicare is required.
Current knowledge and understanding of Medicare regulations related to PACE health plan management is helpful.
Knowledge and experience using Excel, Microsoft Word and ten-key efficiency; ability to quickly adapt to new systems
Strong knowledge of current computer technology, including the use of computers, printers, computerized file structures and associated software
Skilled in establishing and maintaining effective working relationships with co-workers and clients
Skilled in problem resolution; recommends suggestions to increase accuracy and/or efficiency
Detail-oriented with ability to focus on projects for extended periods
Ability to work independently, seeking supervision as needed
Ability to communicate professionally, clearly and effectively, verbally and in writing
Ability to have superior attendance to effectively fulfill all functions of the position
Ability to independently follow through on assigned tasks, without prompting
Ability to prioritize effectively
Ability to consistently multitask
Physical Demands & Requirements:
Communicate by way of the telephone with participants, customers, vendors and staff
Operate a computer and other office productivity machinery, such as a calculator, copy machine, fax machine and office printer
Remain stationary for extended periods of time
Occasionally exert up to 20 pounds of force to lift, carry, push, pull or move objects
Visual acuity to perform activities such as identifying, inputting and analyzing data on a computer terminal and/or in hard copy
Occasional reaching to retrieve shelved items
Occasional bending/stooping
Work Environment:
This job operates in a professional or home office environment with a conversational noise level.
No substantial exposure to adverse environmental conditions is expected
Moderate pressure to meet scheduled appointments and deadlines
Potential for occasional verbal aggression by clients and vendors
Supervised by: Enrollment Supervisor
Job Type: Full-time
Salary: $19.00 - $23.00 per hour
Benefits:
- Dental insurance
- Health insurance
- Paid time off
- Vision insurance
Schedule:
- 8 hour shift
Ability to commute/relocate:
- Maitland, FL 32751: Reliably commute or planning to relocate before starting work (Required)
Application Question(s):
- Do you have experience with health plan management with an insurance company? Prior experience working with enrollments is strongly preferred.
- Please provide a contact number and email address.
- Do you have a working knowledge of Medicare part A? This is a requirement.
Work Location: Hybrid remote in Maitland, FL 32751
Salary : $19 - $23