Analyst, Enrollment (Remote)

Molina Healthcare; Albuquerque (NM); Remote; USD 80,000 - 100,000; Full time

Job summary

A leading healthcare provider in Albuquerque seeks an Enrollment Specialist to manage member records and provide customer service. Responsibilities include processing new members, resolving enrollment issues, and maintaining accurate records. The ideal candidate has an Associate's Degree, 1-3 years of related experience, and strong skills in healthcare processes. This position offers competitive pay in a supportive environment.

Benefits

Competitive benefits package

Equal Opportunity Employer

Qualifications

• 1-3 years of experience required.
• 3-5 years of preferred experience.
• Combination of education and experience in a related field.

Responsibilities

• Prepare, process, and maintain enrollment records.
• Provide customer service to plan members and providers.
• Research and resolve enrollment related questions.

Skills

Healthcare experience

SQL

E2E enrollment processes

Customer service

Education

Associate's Degree

Bachelor's degree in Accounting/Business

Job description

Job Description

Job Description

Job Summary

Responsible for preparation, processing and maintenance of new members and re-enrollment. Processes and maintains health plan's member and enrollment records, employer's monthly reports, sending membership cards and materials. Provide customer service to plan members, providers, and employer groups by answering benefit questions, resolving issues and educating callers. Verify enrollment status, make changes to records, research and resolve enrollment system rejections. Address a variety of enrollment questions or concerns received via mail, phone, or e-mail. Maintain records in the enrollment database

Knowledge/Skills/Abilities

• Manages the daily process of member exceptions from state eligibility file and takes appropriate action to ensure members are properly enrolled.
• Tracks and follows up on any exceptions with revenue amounts expected from the State and maximizes recovery.
• Researches discrepancies from state payments in order to ensure accurate payment to the health plan.
• Compiles and reviews all reports, historical trends and forecasts future enrollment activities.
• Manages and prepares daily performance reports summarizing key performance indicators regarding enrollment statistics.
• Facilitating and coordination of meeting materials with Health Plan Compliance and Operations VPs for multiple states.
• Subject Matter Expert in E2E enrollment processes for multiple states.
• Assist with projects as assigned by Director, Enrollment concerning trending analysis, inventory, or other enrollment-related areas.
• Quality review and submission of deliverables to Molina Healthcare Government Contract and to State Medicaid Agencies.
• Tracking all contractual related tasks to completion.
• Monitor inventory analysis provided by third party vendor for accuracy and explanation.
• Record and publish enrollment events on SharePoint that are available for department and third-party vendor use.
• Assist manager with preparation of submission of Sarbanes-Oxley (SOX) audit data to internal and external auditors.
• Assist with complex enrollment issues concerning member eligibility.
• QNXT
• Healthcare experience
• SQL-preferred

Job Qualifications

Required Education

Associate's Degree or equivalent combination of education and experience

Required Experience

1-3 years

Preferred Education

Bachelor's degree in Accounting and/or Business or equivalent experience

Preferred Experience

3-5 years

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $21.16 - $46.42 / HOURLY

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.