Commercial Enrollment Specialist II

🔥 4 hours ago

🇺🇸 United States – Remote

💵 $40k - $44k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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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

• Prepare, process, and maintain enrollment and disenrollment requests • Verify and maintain applicable eligibility requirements • Review and process CMS transactions • Review Medicaid eligibility and complete verification processes • Resolve enrollment system rejections according to regulatory and client-specific guidelines • Reconcile membership reports as required by CMS • Attend and successfully complete client and employer training • Mentor junior team members • Collaborate on special projects, including process documentation, training, and quality reviews • Communicate with management about issues and concerns and take preventive measures to ensure case accuracy and quality • Participate in management-assigned projects • Perform other assigned duties

🎯 Requirements

• High school degree required • 3–5 years of professional experience processing Medicare enrollment transactions • Thorough understanding of Medicare Advantage products, CMS transaction files, and enrollment-related guidelines • Medicaid enrollment experience is a plus • Experience with CMS interfaces and systems for Medicare Advantage enrollment and billing functions • Ability to analyze enrollment reconciliation data and report SLAs, KPIs, and other operations reports • Ability to present findings in a structured way • Willingness to learn • Ability to collaborate as a team member • Strong work ethic • Ability to adapt quickly to a challenging environment • Self-starter and quick learner • Ability to work across multiple time zones • Candidates may be required to complete a pre-employment criminal background check

🏖️ Benefits

• Training scheduled by the client and employer • Mentorship opportunities • Hybrid or remote work environment • Potential travel dependent on company needs • Reasonable accommodations for individuals with disabilities • Equal opportunity employment • Permanent employment