Medicare & Medicaid Enrollment Analyst

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

📋 Description

• Prepare, submit, and oversee individual and group Medicare revalidations through PECOS.

• Administer Medicare revalidations and enrollment maintenance requests.

• Monitor PTAN assignments, effective dates, and approval statuses.

• Coordinate electronic signatures and necessary documentation for Medicare revalidations.

• Ensure compliance with CMS regulations and Medicare Administrative Contractor (MAC) requirements.

• Submit revalidation Medicaid applications for individual providers and provider organizations.

• Manage state-specific Medicaid enrollment requirements and corresponding documentation.

• Track application status and address deficiencies with state Medicaid agencies.

• Develop and maintain tracking systems for all Medicare and Medicaid revalidation activities.

• Keep a close watch on revalidation due dates, enrollment expirations, and regulatory deadlines.

• Conduct regular follow-ups with Medicare contractors and state Medicaid agencies.

• Ensure accurate documentation and reporting of all enrollment milestones.

• Escalate delayed or high-risk applications to leadership when appropriate.

• Guarantee that all activities comply with CMS, Medicare, Medicaid, and organizational standards.

• Maintain comprehensive and audit-ready enrollment files and supporting documents.

• Assist with internal audits, accreditation reviews, and regulatory requests.

• Monitor changes in Medicare and Medicaid enrollment policies and inform stakeholders of their impacts.

• Implement process improvements to boost enrollment efficiency and accuracy.

• Act as the primary resource for guidance on Medicare and Medicaid revalidation.

• Collaborate with Billing, Revenue Cycle, Credentialing, Compliance, and Operations teams.

• Investigate and resolve enrollment-related billing delays, claim denials, and reimbursement issues.

• Provide status updates and reporting to leadership and operational stakeholders.

⛳️ Requirements

• High School Diploma or equivalent is required.

• At least three years of experience in Medicare and Medicaid.

• Proven experience managing enrollments for both providers and organizations/groups.

• Strong understanding of CMS enrollment regulations, PECOS, Medicare revalidation requirements, and state Medicaid enrollment processes.

• Experience with enrollment tracking systems and provider management platforms.

• Excellent organizational, analytical, and problem-solving abilities.

🏝️ Benefits

• Health insurance

• Professional development opportunities