Medicare Enrollment Specialist

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Come join our Peak Health team at WVU Medicine as a Medicare Enrollment Specialist, contributing to the foundation for an innovative, new health plan. This position will report to the Enrollment Manager, playing a unique and important role in our mission to change healthcare for the better.
Experience in Medicare and critical thinking skills will help the organization build an effective and efficient enrollment team. The enrollment team will review, execute, and oversee the processing of member enrollment application information for Peak Health’s Plan Suite.
The Medicare Enrollment Specialist will analyze and process enrollment forms, checking for validity, completion, and accuracy. Ability to determine whether to enroll, outreach, or reject applications while following organizational policies and procedures is a must. This job reviews and evaluates all documents for quality control for final entry of member enrollment forms.

MINIMUM QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. High School diploma or equivalent

EXPERIENCE:

1. Two (2) year of experience working with medical or institutional data entry.

2. Two (2) year of customer service experience.

OR

One (1) year of Medicare eligibility and Medicare Enrollment processing experience

PREFERRED QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. Associate Degree, or greater, in related healthcare field.

EXPERIENCE:

1. Three (3) to five (5) years of Medicare Enrollment processing and customer service experience.

2. Two (2) years of experience with Medicare elections, transaction codes, and reconciliation operations.

3. Two (2) years managing late enrollment penalty (LEP) for MAPD enrollees.

4. Familiarity with navigating CMS tools and resources, particularly the MARx website.

5. At least one (1) year of experience with system/user acceptance testing.

6. At least one (1) year of experience with developing and delivering trainings.

CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position.  They are not intended to be constructed as an all-inclusive list of all responsibilities and duties.  Other duties may be assigned.

1. Determine accuracy and completions of member form information. Entry/verifies form data.

2. Resolves enrollment issues to assure efficient and seamless member experience. 

3. Maintains Medicare member enrollment records annually, indicating changes, updates, and outreach as required.

4. Meets all production and quality standards, maintaining Workqueues according to department standards.

5. Effectively communicates with internal and external staff.

6. Elevates issues to next level of supervision, as appropriate.

7. Ensures accuracy of data entered and record maintenance.

8. Attends all required training classes, demonstrating proficiency and ability to learn.

9. Manages coordination of benefits (COB) on member records.

10. Develops and Delivers department trainings to new hires.

11. Participates in system testing for any development rollouts.

12. Participates in department planning to ensure a successful Open Enrollment.

13. Other duties as deemed appropriate by the Management Team.

14. Processes SNP applications, verifying eligibility, including but not limited to Dual-Entitlement and residence within the service area.

PHYSICAL REQUIREMENTS: 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. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Ability to sit for extended periods of time.

WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Standard office environment with electrical equipment (i.e., telephone, personal computer, copier, fax machines, etc.)

2. Computer Software/Systems include but not limited to Microsoft Office Professional Suite (Outlook, Word, Excel, Access), Internet Explorer, and EPIC.

SKILLS AND ABILITIES:

1. Familiarity with Medical insurance enrollment processes.

2. Working Knowledge of administrative and clerical procedures and systems such as word processing and managing files and records.

3. Ability to take direction and to navigate through multiple systems simultaneously.

4.  Excellent written and oral communication, customer service, interpersonal skills, and telephone etiquette skills.

5. Ability to solve problems with predefined methods and guidelines to drive improved efficiencies and customer satisfaction.

6. Requires exceptional attention to detail, the ability to be organized and to be able to perform multiple tasks simultaneously.

Additional Job Description:

Scheduled Weekly Hours:

40

Shift:

Exempt/Non-Exempt:

United States of America (Non-Exempt)

Company:

PHH Peak Health Holdings

Cost Center:

2902 PHH Claims Operations