Senior Medicaid Enrollment Specialist

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

📋 Description

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

• Confirm and maintain relevant eligibility criteria.

• Review and process transactions from CMS.

• Assess Medicaid eligibility and finalize verification processes.

• Address enrollment system rejections following regulatory and client-specific protocols.

• Reconcile membership reports as mandated by CMS.

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

• Provide mentorship to junior team members.

• Collaborate on special initiatives, which include process documentation, training, and conducting client quality reviews.

• Maintain open communication with management concerning any issues and concerns.

• Implement preventive measures to ensure the accuracy and quality of cases.

• Engage in projects assigned by management.

• Execute other duties as directed.

⛳️ Requirements

• A minimum of 5 years of professional experience in processing Medicare enrollment transactions.

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

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

• Knowledge of Medicaid is advantageous.

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

• Proficiency in presenting findings in an organized manner.

• High school diploma is mandatory.

• Eagerness to learn.

• Strong collaboration skills.

• A solid work ethic.

• Ability to swiftly adapt to a demanding environment.

• Self-motivated and quick to learn new concepts.

• Willingness to work across various time zones.

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

🏝️ Benefits

• Remote work setting.

• Opportunities for training provided by clients and employers.

• Mentoring and professional growth through participation in special projects.

• Potential travel requirements based on company needs.

• Reasonable accommodations available for individuals with disabilities.

• Commitment to equal opportunity and workforce diversity.