Medicare Enrollment Specialist II

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

📋 Description

• Prepare, process, and manage enrollment and disenrollment requests.

• Verify and uphold relevant eligibility criteria.

• Review and handle CMS transactions.

• Assess Medicaid eligibility and carry out verification processes.

• Address enrollment system rejections in accordance with regulatory and client guidelines.

• Reconcile membership reports as mandated by CMS.

• Create case files for enrollment-related matters submitted to the CMS Contractor for approval and resolution.

• Attend and successfully complete training provided by clients and employers.

• Mentor junior team members.

• Collaborate on special projects, including process documentation, training initiatives, and quality assessments.

• Communicate with management regarding issues and concerns while implementing preventive measures to ensure case accuracy and quality.

• Engage in assigned projects.

• Execute additional duties as required.

⛳️ Requirements

• High school diploma or GED is mandatory.

• A minimum of 2 years of professional experience in processing Medicare enrollment transactions.

• Comprehensive knowledge of Medicare Advantage products, CMS transaction files, and enrollment-related guidelines.

• Experience in Medicaid enrollment is advantageous.

• Familiarity with CMS interfaces and systems pertaining to Medicare Advantage enrollment and billing functions.

• Ability to analyze enrollment reconciliation data effectively.

• Capability to report on SLAs, KPIs, and other operational reports, presenting findings in an organized manner.

• Eagerness to learn.

• Capacity to work collaboratively as part of a team.

• Strong work ethic.

• Ability to swiftly adapt to a dynamic environment.

• Self-motivated and quick to learn.

• Completion of a pre-employment criminal background check may be required.

🏝️ Benefits

• Full-time, permanent employment opportunity.

• Training arranged by the client and employer.

• Chance to mentor junior team members.

• Hybrid or remote working arrangements.

• Potential travel based on company requirements.

• Reasonable accommodations available for individuals with disabilities.

• Equal opportunity employer dedicated to workforce diversity.