What are the responsibilities and job description for the Enrollment Manager (Medicare) position at Solis Health Plans?
POSITION IS ONSITE Mon-Friday, Bilingual in Spanish is required.
Full benefits package offered on the first of the month following date of hire including: Medical, Dental, Vision, 401K with a 100% company match! Our company has double in size and we have experienced exponential growth in membership from 2,000 members to over 10,000 members.
Join our winning Solis Team!
Position Summary:
Essential Duties and Responsibilities:
- Oversees the processing of enrollment and disenrollment elections from Medicare beneficiaries, as well as any other required update to a member record.
- Performs monthly membership audits.
- Monitors FDR eligibility error reports for correction.
- Transmits election information to CMS within specified timeframes and according to CMS regulations.
- Establishes utilization reports to optimize enrollment data.
- Ensures appropriate letters are sent to members within CMS timeframes.
- Analyzes system efficiency and determines adjustments and enhancements as needed.
- Handles all Medicare retroactive processing contractor requests.
- Trains the department staff members and provides them with methods and techniques to perform their job efficiently.
- Assists the department staff members with discrepancies and dispute resolutions.
- Works together with Marketing, Compliance, Claims, Member Services, and Finance departments to enhance member profiles.
- Handles enrollment data validation for CMS and complies with regulatory reporting standards
- Audits data entered into the plans internal systems to ensure data integrity and quality.
- Uses judgment and informed decision-making to determine appropriate actions on elections and in handling discrepancies.
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Meets with Senior VP of Operations and Business Intelligence on a regular basis to:
- Provide feedback on departmental and staff issues/opportunities.
- Staffing requirements and needs.
- Receive feedback on own performance.
- Reviews overtime report and ensures communication with staff as appropriate.
- Ensure compliance with state and federal laws.
- Supervises the department staff members, provides guidance, and evaluates performance as needed.
- Performs all other duties as assigned.
Qualifications and Education:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Graduate of an accredited college or university with at least a Bachelor’s degree in Business Administration, Public Health Administration or related field and four (4) years’ experience working with CMS regulations; or equivalent combination of education and experience.
- Minimum of 2 years’ experience in a demonstrated leadership and management role required.
- Familiarity with healthcare laws, regulations, and standards.
- Working knowledge of the Privacy and Security Health Insurance Portability and Accountability Act (HIPAA) regulations.
- Working knowledge of Medicare and Medicaid enrollment and eligibility requirements and processes
- Excellent customer service skills.
- Excellent listening, interpersonal, verbal and written communication skills with individuals at all levels of the organization.
- Excellent computer knowledge is required, including proficient knowledge of Microsoft Office.
- Ability to create reports from different data pools and present findings efficiently.
- Must be self-motivated, organized and have excellent prioritization skills.
- Must be patient in dealing with an elderly population and sympathetic to hearing or vision deficiencies.
- Ability to work effectively independently and in a team environment.
- Ability to read, analyze, and interpret technical procedures or governmental regulations.
- Ability to write reports, business correspondence, and procedure manuals.
- Ability to effectively present information and respond to questions from groups of managers, clients, customers and the general public.
- Ability to calculate figures and amounts, such as discounts, interest, commissions, proportions, percentages, area and volume.
- Ability to define problems, collect data, establish facts, and draw valid conclusions.
- Strong decision-making, analytical skills.
- Must be able to work well under stressful conditions.
- Must be able to work in a fast-paced environment.
- Fluency in Spanish and English required.
What Sets Us Apart:
Join Solis Health Plans as an Enrollment Manager and become a catalyst for positive change in the lives of our members. At Solis, you will be part of a locally rooted organization deeply committed to understanding and serving our communities. If you are eager to embark on a purpose-driven career that promises growth and the chance to make a significant impact, we encourage you to explore the opportunities available at Solis Health Plans. Join us and be the difference!
