Medicare Enrollment Specialist

🔥 19 hours ago

🇺🇸 United States – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

👻 Ghost score 10%

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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

• Report to the Enrollment Manager • Analyze and process Medicare enrollment forms, checking validity, completion, and accuracy • Determine whether to enroll, conduct outreach, or reject applications according to organizational policies and procedures • Review and evaluate documents for quality control and final entry of member enrollment forms • Determine accuracy and completeness of member form information; enter and verify form data • Resolve enrollment issues to ensure an efficient and seamless member experience • Maintain Medicare member enrollment records, including changes, updates, and outreach • Meet production and quality standards and maintain Workqueues according to department standards • Communicate effectively with internal and external staff • Escalate issues to the appropriate level of supervision • Ensure accuracy of data entry and record maintenance • Attend required training classes and demonstrate proficiency • Manage coordination of benefits (COB) on member records • Develop and deliver department training to new hires • Participate in system testing for development rollouts • Participate in department planning for a successful Open Enrollment • Process SNP applications and verify eligibility, including Dual-Entitlement and residence within the service area

🎯 Requirements

• High School diploma or equivalent AND two (2) years of experience working with medical or institutional data entry AND two (2) years of customer service experience; OR High School diploma or equivalent AND one (1) year of Medicare eligibility and Medicare Enrollment processing experience; OR Bachelor's degree • Preferred: Associate Degree or greater in a related healthcare field • Preferred: three (3) to five (5) years of Medicare Enrollment processing and customer service experience • Preferred: two (2) years of experience with Medicare elections, transaction codes, and reconciliation operations • Preferred: two (2) years managing late enrollment penalty (LEP) for MAPD enrollees • Familiarity with CMS tools and resources, particularly the MARx website • Preferred: at least one (1) year of experience with system/user acceptance testing • Preferred: at least one (1) year of experience developing and delivering trainings • Familiarity with medical insurance enrollment processes • Working knowledge of administrative and clerical procedures and systems, including word processing and managing files and records • Ability to take direction and navigate multiple systems simultaneously • Excellent written and oral communication, customer service, interpersonal, and telephone etiquette skills • Ability to solve problems using predefined methods and guidelines • Exceptional attention to detail, organization, and ability to perform multiple tasks simultaneously • Ability to sit for extended periods • Proficiency with Microsoft Office Professional Suite (Outlook, Word, Excel, Access), Internet Explorer, and EPIC

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