Medicare Enrollment Specialist II

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🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $40k - $44k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

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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 • Build case files for enrollment-related issues sent to the CMS Contractor for approval and resolution • Research and resolve enrollment and billing discrepancies • Mentor junior team members • Collaborate on special projects, including process documentation, training, and client quality reviews • Communicate with management regarding issues and concerns and take preventive measures to ensure case accuracy and quality • Participate in management-assigned projects and perform other assigned duties

🎯 Requirements

• High school diploma or GED required • 2 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 collaborate • Candidates may be required to complete a pre-employment criminal background check

🏖️ Benefits

• Trainings scheduled by the client and employer • Opportunity to mentor junior team members • Opportunity to participate in special projects and process documentation development • Work in a hybrid or remote work environment • Equal opportunity employer committed to workforce diversity • Reasonable accommodations for individuals with disabilities • Potential travel dependent on company needs