Enrollment Analyst – ACA Enrollment

This is a fully remote position, open to applicants in Virginia, +1 more state.

📋 Description

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

• Manage weekly enrollment files and daily transactions related to ACA/Marketplace enrollments.

• Reconcile records pertaining to membership, coverage, Marketplace, issuers, and CMS.

• Maintain comprehensive member enrollment records, including APTC and CSR details.

• Handle new enrollments, maintenance transactions, cancellations, terminations, reinstatements, plan changes, SEP requests, SNP applications, and 834 transaction files.

• Address enrollment discrepancies, transaction errors, rejections, exceptions, and issues regarding eligibility.

• Complete monthly EDV processes, REED submissions, LEP data files, MPWR files, and CMS reconciliation tasks.

• Monitor enrollment work queues and adhere to production, quality, CMS, and organizational timeliness standards.

• Respond to member inquiries about enrollment procedures, benefits, and eligibility criteria.

• Develop and deliver training for new hires in the department, and maintain job aids and standard operating procedures.

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

• Analyze enrollment data, identify trends and discrepancies, and prepare reports for management.

• Ensure compliance with CMS Marketplace regulations, federal and state laws, issuer guidelines, and internal policies.

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

• Maintain enrollment databases and software while troubleshooting any system-related issues.

⛳️ Requirements

• High school diploma or equivalent qualification.

• A minimum of three (3) years of experience in medical or institutional data entry.

• At least three (3) years of customer service experience.

• Two (2) years of experience with Medicare eligibility and Medicare Enrollment processing.

• Preferred: Three (3) or more years of experience in ACA/Marketplace enrollment processing.

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

• Knowledge of Health Insurance Marketplace eligibility and enrollment regulations.

• Familiarity with Medicare elections, transaction codes, reconciliation operations, LEP, CMS tools/resources, MARx, EDVs, REED submissions, COB payment orders, and Tapestry’s AFO table.

• At least one (1) year of experience in system/user acceptance testing.

• A minimum of one (1) year of experience in developing and delivering training programs.

• Prior experience with EMR systems.

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

• Ability to navigate multiple systems simultaneously and work independently with minimal supervision.

• Familiarity with medical insurance, ASO/Commercial, Medicare, and ACA/Marketplace enrollment procedures.

• Exceptional attention to detail, organization, multitasking, planning, documentation, analytical, and problem-solving skills.

• Proficiency in Microsoft Office Professional Suite, Internet Explorer, and EPIC.

• Capability to sit for extended periods.

🏝️ Benefits

• Competitive salary and comprehensive health benefits.

• Opportunities for professional development and training.

• Flexible working hours and a supportive work environment.

• Employee wellness programs and incentives.