Enrollment Specialist

Position Purpose:

This position is responsible for performing activities and functions related to enrollment of new business, audit new and renewal business and ensure that groups and members are enrolling based on eligibility requirements for Hometown Health's commercial insurance, self-funded and Medicare product lines. In addition, works as a system lead and is responsible for knowledge and expertise on all enrollment systems, processes and functions.

Nature and Scope:

Under the direction of department Leadership, the Enrollment Specialist will coordinate staff to successfully verify eligibility and complete all enrollment transactions for Medicare, Individual and Family plans, Small and Large Group clients and the enrollment administrative requirements for its third-party administrator business including but not limited to large group TPA and the Independence Plan clients.

The position responsibilities include:

·         Strict adherence to all Federal and State regulations and our State of Nevada department of insurance guidelines.

• Strict adherence to eligibility and enrollment criteria governed by the Centers for Medicare & Medicaid Services (CMS) Medicare Managed Care Manual.  Responsible for updating and creating Policy and Procedures for Enrollment.
• Overseas and directs Enrollment Team in prioritizing work as business needs change.
• Responsible for auditing and testing membership system upgrades.
• Front line audit support with Auditors (internal & external) for annual filings.
• Participates with Configuration Analyst to create processes to maximize accuracy and quality measures required by departmental success.

·         Department expert for all enrollment systems processes and functions.

·         Trains and mentors new Enrollment Representatives.

·         Providing informal enrollment department leadership in the absence of Revenue and Enrollment Leadership.

·         Responsible for auditing Enrollment Representative work to verify enrollment entered is in compliance with the group's Eligibility Provision, the commercial Evidence of Coverage, the Group Subscription Agreement and the Summary Plan Documents for self funded clients.

·         Works on multiple complex transactions with high quality results and adherence to deadlines. 

·         Manages Employer group and member relationships ensuring enrollment is processed timely and accurately to avoid delay of enrollment, termination or disruption of their benefit plan when information received is not complete. 

• Maintain regular communication with Leadership, Configuration Analysts and customers.
• Verifying eligibility in multiple databases, including but not limited to the Medicare Advantage Prescription Drug (MARx) system,  Group Eligibility Provision, Evidence of Coverage Document, Group Subscription  Agreement, Group Self Funded Summary Plan Document, Departmental policies & procedures, Provider Directory before coding and entering membership into the Hometown Health's managed care information system.
• Performing critical thinking and analysis in determining the appropriate group, benefit package and riders to assign to members.
• Performs special projects including but not limited to system implementations as assigned by Leadership.
• Works directly with the Information Technology team in reporting and testing electronic file issues.
• Cross Trains in Revenue Department.

·         Performing other revenue-related duties as assigned.

This position does not provide patient care.

Incumbent is expected to type a minimum of 45 WPM adjusted for error.  Must have strong computer skills, including but not limited to, expert level understanding of Microsoft Office Suite, including Outlook, intermediate skills in Excel spreadsheets and formulas in addition to possessing basic Word skills. 

The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.

Minimum Qualifications:  Requirements - Required and/or Preferred

Education:

Must have working level knowledge of the English language, including reading, writing and speaking. Bachelor's degree from an accredited college or university or equivalent experience is required. . Computer literacy, intermediate word processing/excel spreadsheet skills and 45 wpm typing ability essential.

Experience:

Four years of business office experience required. Experience in an insurance setting preferred.

License(s):

None

Certification(s):

None

Computer / Typing:

Must have within 90 days the ability to use the computers skills necessary to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc.