Enrollment Analyst – ACA Enrollment

Job not on LinkedIn

🕒 August 5

⚔️ Virginia, West Virginia – Remote

⚔️ Virginia – Remote ⛰️ West Virginia – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

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WVU Medicine

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance

WVU Medicine is a comprehensive health system affiliated with West Virginia University, providing medical services through a network of hospitals across West Virginia. The system includes notable facilities such as J. W. Ruby Memorial Hospital, WVU Medicine Children's, and various other regional medical centers. WVU Medicine offers a wide range of healthcare services, including specialized and advanced medical treatments such as robotic heart surgery. It's also involved in medical education, research, and community health initiatives, emphasizing a mission of delivering high-quality care to the communities it serves.

📋 Description

• Review, execute, and oversee processing of member enrollment application information for Peak Health’s Plan Suite • Manage weekly enrollment files and daily ACA/Marketplace enrollment transactions • Reconcile membership, coverage, Marketplace, issuer, and CMS records • Maintain member enrollment records, including APTC and CSR information • Process new enrollments, maintenance transactions, cancellations, terminations, reinstatements, plan changes, SEP requests, SNP applications, and 834 transaction files • Resolve enrollment discrepancies, transaction errors, rejects, exceptions, and eligibility issues • Complete EDV monthly processes, REED submissions, LEP data files, MPWR files, and CMS reconciliation processes • Monitor enrollment work queues and meet production, quality, CMS, and organizational timeliness standards • Respond to member inquiries regarding enrollment procedures, benefits, and eligibility requirements • Develop and deliver department training to new hires and maintain job aids and standard operating procedures • Participate in system testing, UAT, validation activities, Open Enrollment planning, and process improvement initiatives • Analyze enrollment data, identify trends and discrepancies, and prepare management reports • Ensure compliance with CMS Marketplace regulations, federal and state regulations, issuer guidelines, and internal policies • Collaborate with underwriting, billing, customer service, Marketplace representatives, vendors, and other stakeholders • Maintain enrollment databases and software and troubleshoot system-related issues

🎯 Requirements

• High school Diploma or equivalent • Three (3) years of experience working with medical or institutional data entry • Three (3) years of customer service experience • Two (2) years of Medicare eligibility and Medicare Enrollment processing experience • Preferred: Three (3) or more years of ACA/Marketplace enrollment processing experience • Experience working with Federally Facilitated Marketplace (FFM) enrollment operations • Familiarity with Health Insurance Marketplace eligibility and enrollment regulations • Familiarity with Medicare elections, transaction codes, reconciliation operations, LEP, CMS tools/resources, MARx, EDVs, REED Submissions, COB payment orders, and Tapestry’s AFO table • At least one (1) year of experience with system/user acceptance testing • At least one (1) year of experience with developing and delivering trainings • Previous experience in EMR systems • Working knowledge of administrative and clerical procedures, word processing, and managing files and records • Ability to navigate multiple systems simultaneously and work with minimal supervision • Familiarity with medical insurance, ASO/Commercial, Medicare, and ACA/Marketplace enrollment processes • Exceptional attention to detail, organization, multitasking, planning, documentation, analytical, and problem-solving abilities • Proficiency with Microsoft Office Professional Suite, Internet Explorer, and EPIC • Ability to sit for extended periods of time