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 procedures.

• Resolve enrollment system rejections according to regulatory and client-specific guidelines.

• Reconcile membership reports as needed by CMS.

• Attend and successfully complete training sessions scheduled by clients and employers.

• Mentor junior team members.

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

• Communicate with management regarding issues and concerns, taking proactive measures to ensure case accuracy and quality.

• Participate in projects assigned by management.

• Perform additional tasks as assigned.

• Research and resolve discrepancies in enrollment and billing.

• Compile case files submitted to the CMS Contractor for approval and resolution.

⛳️ Requirements

• High school diploma required.

• 3-5 years of professional experience in processing Medicare enrollment transactions.

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

• Experience with Medicaid enrollment is advantageous.

• Familiarity with CMS interfaces and systems for managing Medicare Advantage enrollment and billing operations.

• Ability to analyze enrollment reconciliation data and report SLAs, KPIs, and other operational metrics, presenting findings in a structured manner.

• Eagerness to learn.

• Team player.

• Strong work ethic.

• Ability to quickly adapt to a challenging environment.

• Self-motivated and quick learner.

• Ability to collaborate effectively.

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

• Capacity to work across multiple time zones in a hybrid or remote setting.

• Ability to sit or stand for extended periods while using video technology on a computer.

🏝️ Benefits

• Remote work environment.

• Training provided by the client and employer.

• Opportunities for mentoring.

• Travel may be required based on company needs.

• Reasonable accommodations available for individuals with disabilities.

• Commitment to equal opportunity employment.