Enrollment Specialist

Position Summary:

The Enrollment Specialist is responsible for providing world class service for each ApexHealth member. This position will serve as the subject matter expert for enrollment and disenrollment for Medicare beneficiaries on our plan, while creating an experience that exceeds expectations in every interaction.

Essential Function:

  • Prepare, process, and maintain enrollment and disenrollment requests
  • Verify and maintain all applicable eligibility requirements
  • Review and process CMS transactions
  • Reconcile eligibility discrepancies and submit retroactive eligibility changes as needed
  • Support the overall success of achieving organization-wide goals, including but not limited to, enrollment, quality, health outcomes, and customer satisfaction
  • Conduct monthly enrollment data validations (EDV’s)
  • Work with other departments on cross-functional tasks, projects, and follow-up
  • Reconcile payment discrepancies and submit retroactive eligibility changes as needed
  • Submit and oversee Late Enrollment Penalty attestations and appeals
  • Prepare necessary member correspondence
  • Document all correspondence and activities through the Customer Relationship Management (CRM) application
  • Identify trends that may lead to policy updates or process improvements that support the superior model and/or impact quality and departmental performance standards
  • Exceed performance and quality standards based on department metrics
  • Work with Enrollment Operations Team Lead to ensure departmental policies are up to date and receive appropriate committee approval
  • Perform other duties as assigned

Job Requirements:

Education:

  • Bachelor’s Degree (or an equivalent) is preferred but not required

Experience:

  • One (1) year of Medicare enrollment/Medicare Managed Care or related healthcare industry experience is preferred
  • Experience with CMS system is preferred

Knowledge:

  • Knowledge and understanding of enrollment and disenrollment processes
  • Basic knowledge of Medicare and/or Medicare Advantage program(s) is preferred
  • Familiarity with Medicare Terminology is preferred

Skills:

  • Computer and data entry skills are required
  • Superior analytical skills are required
  • Excellent written and verbal communication skills are required

Abilities:

  • Ability and desire to exceed expectations in all facets of the job
  • Ability to create rational summarization of analysis
  • Ability to speak effectively to and with small or large groups
  • Ability to problem solve

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