Medicare Enrollment Specialist II

🔥 14 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.

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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 based on regulatory and client-specified guidelines • Reconcile membership reports as required by CMS • Attend and successfully complete client- and employer-scheduled trainings • 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 • Research and resolve enrollment and billing discrepancies • Build case files sent to the CMS Contractor for approval and resolution

🎯 Requirements

• High school degree required • 3-5 years of professional experience in processing Medicare enrollment transactions • Thorough understanding of Medicare Advantage products, CMS transaction files, and corresponding enrollment-related guidelines • Medicaid enrollment experience is a plus • Experience with CMS interfaces and systems for managing Medicare Advantage enrollment and billing functions • Ability to analyze enrollment reconciliation data and report SLAs, KPIs, and other operations reports and present findings in a structured way • Willingness to learn • Team collaborator • Strong work ethic • Ability to adapt quickly to a challenging environment • Self-starter and quick learner • Ability to collaborate • Candidates may be required to complete a pre-employment criminal background check • Ability to work across multiple time zones in a hybrid or remote work environment • Ability to work long periods sitting and/or standing in front of a computer using video technology

🏖️ Benefits

• Remote work environment • Training scheduled by the client and employer • Mentoring opportunities • May require travel dependent on company needs • Reasonable accommodations for individuals with disabilities • Equal opportunity employment