Enrollment Analyst – ACA Enrollment

This is a fully remote position, open to applicants in United States.

📋 Description

• Review, execute, and supervise the processing of member enrollment application information for Peak Health’s Plan Suite.

• Oversee weekly enrollment files and daily ACA/Marketplace enrollment transactions.

• Handle new enrollments, maintenance transactions, cancellations, terminations, reinstatements, plan changes, and SEP requests.

• Reconcile membership, coverage, Marketplace, CMS, and issuer records; address discrepancies, errors, rejects, and exceptions.

• Maintain records for member enrollment, APTC/CSR information, databases, and work queues.

• Validate applicant eligibility, household information, coverage effective dates, enrollment status, and required documentation.

• Process and investigate 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, conducting audits to ensure regulatory compliance.

• Address member inquiries related to enrollment procedures, benefits, and eligibility.

• Develop and provide enrollment training for new hires, while also maintaining job aids and standard operating procedures.

• Participate in system testing, UAT, validation activities, Open Enrollment planning, and initiatives for process improvement.

• Analyze enrollment data, generate management reports, identify trends and discrepancies, and suggest enhancements.

• Collaborate with underwriting, billing, customer service, Marketplace representatives, vendors, and other stakeholders.

• Appropriately escalate issues and troubleshoot problems related to the enrollment system.

⛳️ Requirements

• High school diploma or equivalent.

• Three years of experience in medical or institutional data entry.

• Three years of customer service experience.

• Two years of experience in Medicare eligibility and Medicare enrollment processing.

• Preferred: three or more years of experience in ACA/Marketplace enrollment processing.

• Experience with Federally Facilitated Marketplace (FFM) enrollment operations.

• Familiarity with Health Insurance Marketplace eligibility and enrollment regulations.

• Knowledge of Medicare elections, transaction codes, reconciliation operations, LEP management, CMS tools, MARx, EDVs, and REED submissions.

• At least one year of experience in system/user acceptance testing.

• At least one year of experience in developing and delivering training sessions.

• Prior experience with EMR systems.

• Working knowledge of administrative and clerical procedures, word processing, and records management.

• Ability to navigate multiple systems concurrently 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 skills.

• Proficiency in Microsoft Office Professional Suite, including Outlook, Word, Excel, and Access, as well as Internet Explorer and EPIC.

• Ability to sit for extended periods.

🏝️ Benefits

• Comprehensive health insurance options.

• Retirement savings plan with employer matching.

• Generous paid time off and holiday schedule.

• Opportunities for professional development and training.

• Supportive team environment and company culture.