**Job Summary:**
We are seeking an experienced Enrollment Manager to join our team. The Enrollment Manager is responsible for managing enrollment activities to facilitate and enhance the company’s operational goals. Ensure the accurate, timely processing and data entry of Medicare enrollments, reenrollments and disenrollments and any subsequent maintenance. Must adhere to all regulatory requirements relating to Enrollment activities and address any questions or concerns in relation to enrollment. Maintain all enrollment records.
**Responsibilities:**
- Responsible for preparation, timely processing of enrollment applications, management, and maintenance in accordance with CMS regulations. Ensures compliance with all applicable policies, processes, and procedures.
- Oversees the enrollment activities and reconciliation.
- Strong knowledge of the Enrollment process along with State, Federal, and business regulatory requirements and other state specific applications concerning Managed Care Enrollment
- Ensure quality control of data entered into membership data base and sent to external vendors.
- Oversees and participates in state, federal, and internal audits, as needed.
- Responsible for the accurate and timely dissemination of eligibility data to the network, ancillary providers, and internal systems.
- Partners with external vendors and is responsible for contracts for Medicare enrollment file transactions to CMS, ID Card printing and mailing and other vendors in support of eligibility operations.
- Oversees external vendors on the development and implementation of tactical initiatives and processes that improve our retention efforts among current members.
- Ensures staff is complaint with regulatory and company guidelines, including HIPAA compliance.
- Measures and monitors the status of goal achievement.
- Oversee and manage the auditing of enrollment and disenrollment information data and certify its completion and accuracy.
- Develop, create, and implement policies and procedures, workflows and job aides as required to provide training for the Enrollment department.
- Reconcile monthly payments (Monthly Reply Listing Report) and discrepancies between data submitted to CMS and the Plan
- Responsible for ensuring timely reconciliation of eligibility files and adjustments to CMS that meet regulatory and health plan requirements, as required.
- Coordinate and manage the generation and mailing of all necessary correspondence relating to enrollment, re-enrollment, and disenrollment in accordance with CMS time frames.
- Partners with vendor management team and the external vendor to ensure service level agreements and regulatory requirements are met.
- Responsible for communicating and following up on files delayed by CMS and/or State or issues with a file that require Health Plan involvement.
Requirements and Skills
- High School Diploma
- CMS Chapter 2 knowledge
- Minimum two years experience with Medicare Advantage Experience is Required
- CMS Transaction Files and 834
- Partners with any external vendor(s) to ensure service level agreements and regulatory requirements are met.
- Proficient with Microsoft Office applications, including Word, Excel, Outlook and various database applications.
- Detail oriented with problem-solving abilities. Strong and effective verbal and written communication skills to multi- level audiences.
- Exemplary interpersonal and customer service skills. Demonstrates professionalism, poise, tact, and diplomacy in interactions with others.
- Demonstrates good judgment, organization and prioritization skills and time management skills.
- Proven leadership with staff, projects, and management.
- Strategic thinking abilities and analytical skills
- Ability to clearly present written information and findings, concisely communicate concepts and make executive-level presentations.
- Knowledge of health plan benefits, processes and Operations
- Prior experience with Commercial and Medicare Advantage Plans
- Working knowledge of Microsoft products
- Excellent time management skills and ability to prioritize work
- Attention to detail and problem solving
- Excellent communication skills
- TPA Experience preferred
- Work weekends and company holidays as needed based on business needs
- Detailed Oriented with the ability to conduct research and identify steps to resolve issues to completion
- Ability to assume responsibility and exercise good judgment when making decisions within the scope of the position
Job Type: Full-time
Pay: $100,000.00 - $130,000.00 per year
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Paid time off
- Vision insurance
Weekly day range:
- Monday to Friday
- Weekends as needed
Work setting:
Application Question(s):
- Do you have at least 2 years of experience working with Medicare Advantage?
- Do you have CMS Chapter 2 knowledge?
Work Location: Remote