What are the responsibilities and job description for the Medicare Enrollment Processor Sr. position at Ohm Systems?
Summary :
A healthcare organization is seeking an Enrollment Specialist to ensure timely and accurate processing of Medicare enrollments, disenrollments, and eligibility changes. This role involves compliance with CMS regulations, reconciliation reporting, and responding to member and provider inquiries. The ideal candidate will have experience in managed care enrollment and a strong understanding of Medicare processes and regulations.
Position Info :
Title : Medicare Enrollment Processor Sr.
Client : AmeriHealth Caritas
Duration : 3 Months
Location : 200 Stevens Drive, Philadelphia PA 19113
Work Mode : Remote work (Training is Onsite)
Responsibilities :
Process enrollment applications, disenrollments, cancellations, and eligibility changes.
Ensure CMS-required materials are mailed within required timeframes.
Manage daily Transaction Reply Reports from CMS and reconciliation reports.
Investigate and resolve enrollment-related inquiries from members, providers, and internal teams.
Conduct root cause analysis for enrollment escalations, including CTM complaints, appeals, and grievances.
Identify system issues and recommend solutions for process improvements.
Maintain data integrity of enrollment records and remittance files.
Develop and implement training programs for Med D Enrollment employees.
Support quality assurance and compliance monitoring in enrollment operations.
Skills / Qualifications :
3-5 years of experience in enrollment processing (preferred).
Strong knowledge of Medicare regulations, CMS guidelines, and managed care enrollment (MA, MAPD, PDP, MMP).
Experience with BAE, LEP, LIS, and billing / enrollment research.
Proficiency in Microsoft Office (Excel, Access, Word, Outlook).
Strong problem-solving skills and ability to perform in a fast-paced environment.
Experience in quality assurance, reconciliation reporting, and process documentation.
Excellent organizational, written, and verbal communication skills.
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