Enrollment Analyst – ACA Enrollment

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Peak Health

WebsiteLinkedInAll Job Openings

51 - 200 employees

🏥 Healthcare

💼 Consulting

🛡️ Insurance

Healthcare • Consulting • Insurance

Peak Health is a health insurer and health insurance services company headquartered in Morgantown, West Virginia. It is owned by three not-for-profit health care providers: WVU Health System, Marshall Health Network, and Valley Health. Peak Health aims to improve community health outcomes by offering an inclusive, provider-led health plan for residents of West Virginia and surrounding areas. The company is committed to making health care more accessible, understandable, and collaborative, with a focus on reducing costs and administrative fees for patients and employers. Peak Health also offers Medicare Advantage coverage tailored for West Virginia seniors through partnerships with leading health systems.

📋 Description

• Review, execute, and oversee member enrollment application information processing for Peak Health’s Plan Suite • Manage weekly enrollment files and daily ACA/Marketplace enrollment transactions • Process new enrollments, maintenance transactions, cancellations, terminations, reinstatements, plan changes, and SEP requests • Reconcile membership, coverage, Marketplace, CMS, and issuer records; resolve discrepancies, errors, rejects, and exceptions • Maintain member enrollment records, APTC/CSR information, databases, and work queues • Validate applicant eligibility, household information, coverage effective dates, enrollment status, and supporting documentation • Process and research SNP, ACA/FFM, Medicare, and ASO enrollment applications and transactions • Complete EDV monthly processes, REED submissions, CMS reconciliations, LEP data files, and MPWR files • Monitor production and quality standards and conduct audits for regulatory compliance • Respond to member inquiries regarding enrollment procedures, benefits, and eligibility • Develop and deliver enrollment training for 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, prepare management reports, identify trends and discrepancies, and recommend improvements • Collaborate with underwriting, billing, customer service, Marketplace representatives, vendors, and other stakeholders • Escalate issues appropriately and troubleshoot enrollment system problems

🎯 Requirements

• High school diploma or equivalent • Three years of experience working with medical or institutional data entry • Three years of customer service experience • Two years of Medicare eligibility and Medicare enrollment processing experience • Preferred: three 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 management, CMS tools, MARx, EDVs, and REED submissions • At least one year of system/user acceptance testing experience • At least one year of experience developing and delivering trainings • Previous experience in EMR systems • Working knowledge of administrative and clerical procedures, word processing, and records management • Ability to navigate multiple systems simultaneously and work with minimal supervision • Familiarity with medical insurance, ASO/Commercial, Medicare, and coordination of benefits enrollment processes • Familiarity with Tapestry’s automatic filing order table • Exceptional attention to detail, organization, multitasking, planning, documentation, analytical, and problem-solving abilities • Proficiency with Microsoft Office Professional Suite, including Outlook, Word, Excel, and Access, Internet Explorer, and EPIC • Ability to sit for extended periods