Medicare Enrollment Specialist II

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

📋 Description

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

• Verify and uphold relevant eligibility criteria.

• Review and manage CMS transactions.

• Assess Medicaid eligibility and execute verification processes.

• Address enrollment system rejections in accordance with regulatory and client-specific standards.

• Reconcile membership reports as mandated by CMS.

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

• Investigate and rectify enrollment and billing discrepancies.

• Mentor junior team members.

• Collaborate on special projects, which include process documentation, training, and client quality assessments.

• Communicate with management regarding concerns and issues, taking proactive steps to ensure accuracy and quality of cases.

• Engage in management-assigned projects and carry out other designated responsibilities.

⛳️ Requirements

• High school diploma or GED is mandatory.

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

• Comprehensive understanding of Medicare Advantage products, CMS transaction files, and enrollment-related protocols.

• Experience in Medicaid enrollment is advantageous.

• Familiarity with CMS interfaces and systems related to Medicare Advantage enrollment and billing operations.

• Capability to analyze enrollment reconciliation data and report on SLAs, KPIs, and other operational metrics.

• Ability to present insights in an organized manner.

• Eagerness to learn.

• Team collaboration skills.

• Strong work ethic.

• Capacity to quickly adapt to a dynamic environment.

• Self-motivated and a fast learner.

• Collaboration skills are essential.

• Candidates may need to undergo a pre-employment criminal background check.

🏝️ Benefits

• Training sessions organized by both the client and the employer.

• Opportunity to mentor junior team members.

• Chance to engage in special projects and contribute to process documentation development.

• Flexible work arrangements, including hybrid or remote options.

• Commitment to being an equal opportunity employer, fostering workforce diversity.

• Provision of reasonable accommodations for individuals with disabilities.

• Potential travel may be required based on company needs.