Enrollment Specialist

What We Provide

What You Will Do

• Monitors all enrollments files tied to automated application processing. Performs daily review and analyses of success and failure reports pertaining to external broker enrollment files, Medicaid eligibility files, EZ enrollment files, and Third Party Administrator (TPA) enrollment files. Ensures that enrollment data is transmitted between all entities involved and processed in accordance with CMS guidelines and plan polices and procedures.
• Reviews and processes new Medicare enrollment requests; determines the appropriate outcome (enroll, deny, additional information required). Identifies errors and discrepancies with application data and works with internal and external sales brokers on resolutions. Follows-up with applicants as necessary.
• Receives and processes enrollment plan change requests for members that choose to change plan options. Monitors process and works with TPA to ensures request if finalized.
• Produces and reviews various sales enrollment system reports to monitor the status of sales reps leads and applications. Reports issues and/or potential problems to management staff.
• Prepares daily sales and enrollment reports for distribution to program staff to be used for financial planning and monitoring of internal/external sales reps progress. Prepares similar reports TPA Enrollment staff used to perform daily reconciliation of enrollments. Validates report data, modifies report as necessary to accommodate changing business needs.
• Monitors Primary Care Physician (PCP) selection process to maximize compliance in choosing in-network PCPs. Reviews out-of-network reports and coordinates between TPA, sales and members services staff in order to move members to in-network PCPs.
• Ensures plan acknowledgement correspondence is sent to all applicants on a timely basis. Creates, prints and distributes letters within specified timeframes.
• Updates sales enrollment system to reflect data from TPA and responds to Sales Rep inquires and questions.
• Prepares supporting enrollment and financial reports and submits to Management for approval.
• Works with Operations staff on improving sales and membership systems and processes. Makes recommendations, assists in developing processes and tests systems design as appropriate.
• Provides support to internal and external sales staff in the area of enrollment eligibility, membership queries, application processes, etc. Handles all pre-member questions and queries.
• Researches and responds to member related queries from contracted sources such as TPA and other vendor providers.
• Produces statistical reports for on a weekly, monthly or ad-hoc basis for compliance, sales and medical management departments.
• Reviews weekly CMS Transaction Reply Reports (TRR) and send reports to Sales Reps with their membership cancellations and disenrollment along with supporting reasons. Tracks Sales Reps responses and prepares additional reports as required.
• Provides administrative and telephonic support to Medicare Advantage departments as needed.
• Acts as a resource to Reconciliation Analyst for assistance and guidance. Provides analytical support to MEU management staff.
• Participates in special projects and performs other duties as assigned.

Education:

• Bachelor's Degree in Business Administration or other related discipline required

Work Experience:

• Minimum two years enrollment and customer service experience in a health care setting required
• Working knowledge of CMS enrollment requirements and a good understanding of membership application processing operations required
• Has the ability to work independently and is self motivated required
• Effective oral and written communication skills required
• Has excellent interpersonal skills and is customer friendly focused required
• Advanced proficiency in Microsoft applications software, including Microsoft Word Excel and Access required