Medicaid Senior Enrollment Specialist

• Be responsible for preparing, processing, and maintaining enrollment and disenrollment requests

• Be responsible to verify and maintain all applicable eligibility requirements

• Be responsible to review and process CMS transactions

• Be responsible to review Medicaid eligibility and complete verification processes

• Be responsible to resolve enrollment system rejections based on regulatory and client specified guidelines

• Be responsible to reconcile membership reports as required by CMS

• Be accountable to attend and successfully complete the trainings scheduled by the client and employer

• Mentor junior members of the team

• Collaborate with other team members on special projects; special projects can include process documentation development, training, quality reviews for the client(s), or any other project as determined by management

• Establish and maintain an appropriate level of communication with management to address issues and concerns and take preventive measures that ensure case accuracy and quality

• Participate in projects as assigned by management

• Perform other duties as assigned

• 5+ years of professional experience in processing Medicare enrollment transactions

• A thorough understanding of Medicare Advantage products, CMS transaction files, and the corresponding enrollment-related guidelines

• Experience with CMS interfaces and systems for managing the Medicare Advantage enrollment and billing functions; Medicaid knowledge is a plus.

• Ability to analyse enrollment reconciliation data and report SLAs, KPIs, and other operations reports and present findings in a structured way

• High school degree required

• Willingness to learn

• Team collaborator

• Strong work ethic

• The ability to adapt quickly to a challenging environment

• A self-starter and quick learner

• Ability to collaborate

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job:

• The employee is occasionally required to move around the office. Specific vision abilities required by this job include close vision, color vision, peripheral vision, depth perception, and ability to adjust focus.
• Work across multiple time zones in a hybrid or remote work environment.
• Long periods of time sitting and/or standing in front of a computer using video technology.
• May require travel dependent on company needs.

The above statements are intended to describe the general nature and level of the job being performed by the individual(s) assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skills required. HealthEdge reserves the right to modify, add, or remove duties and to assign other duties as necessary. In addition, reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position in compliance with the Americans with Disabilities Act of 1990. Candidates may be required to go through a pre-employment criminal background check. HealthEdge is an equal opportunity employer. We are committed to workforce diversity and actively encourage all qualified persons to seek employment with us, including, but not limited to, racial and ethnic minorities, women, veterans and persons with disabilities.