Enrollment Team Lead

🕒 August 18

🇺🇸 United States – Remote

💵 $95k - $103k / year

⏰ Full Time

🟠 Senior

🦅 H1B Visa Sponsor

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HealthEdge

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2005

🏥 Healthcare

💼 Consulting

⚕️ Healthcare Insurance

Healthcare • Consulting • Healthcare Insurance

HealthEdge is a company that specializes in providing advanced solutions for healthcare payers through its HealthRules Solutions Suite. This suite includes a comprehensive digital claims administration processing system, care management workflow solutions, and payment integrity solutions, which aim to enhance operational efficiency and improve quality of care for health plans. By leveraging integrated technology and automation, HealthEdge helps health plans eliminate data silos, increase payment accuracy, and elevate member experience, thereby transforming the healthcare landscape for better collaboration and accessibility.

📋 Description

• Report to the Enrollment Manager • Support key processes ensuring smooth operation of the Enrollment Operations Business Unit • Help oversee onshore and offshore enrollment specialists • Manage and process discrepancy queues, RPC, LEP, briefcases, and JIRA tickets • Assist with audits • Oversee correspondence submissions • Generate client reports • Maintain inboxes and delegate tasks • Interpret regulations and guidance under the CMS Manual System and other regulatory agency guidelines • Assist with developing and reviewing policies and procedures for CMS compliance • Research, analyze, and disseminate CMS guidance and communications • Partner with business units to develop and improve workflows and business processes • Recommend ongoing improvements to core processes and support positive SLA results • Answer questions and provide information, coaching, and training to onshore and offshore personnel • Write and maintain documents related to Enrollment’s internal functions • Serve as a Lead Enrollment SME

🎯 Requirements

• 7+ years’ experience in a related field, typically in two subject areas • Thorough understanding of Medicare Advantage products • Knowledge of CMS transaction files and enrollment-related guidelines • Experience with CMS interfaces and systems for Medicare Advantage enrollment and billing • Ability to analyze enrollment reconciliation data • Ability to report SLAs, KPIs, and other operations reports and present findings in a structured way • Bachelor’s degree in a related field; relevant combination of education and experience may be considered in lieu of a degree • Proficiency in current industry-standard PC applications and systems, including Access, Excel, Word, and PowerPoint • Willingness to learn • Team collaboration • Significant creativity and flexibility • Strong work ethic • Ability to work across multiple time zones in a hybrid or remote work environment • May be required to complete a pre-employment criminal background check

🏖️ Benefits

• Remote work environment • Hybrid or remote work environment • May require travel dependent on company needs • Reasonable accommodations for individuals with disabilities • Equal opportunity employer committed to workforce diversity