Enrollment Specialist

Socket.dev; Chicago (IL); On-site; USD 42,000 - 68,000; Full time

Job summary

Zing Health Plan is seeking an Enrollment Specialist to join our Enrollment Team. The Enrollment Specialist is responsible for performing duties related to enrollment of Medicare beneficiaries and making eligibility determinations based on CMS Part A/Part B guidelines.

The role requires processing enrollments and disenrollments, maintaining accurate member records, and ensuring compliance with CMS and Zing Health policies.

Qualifications

• Bachelor’s degree preferred.
• Knowledge of managed care operations.
• Ability to work independently, set priorities and meet deadlines.
• 1+ years’ experience with Medicare preferred.
• Strong knowledge/Proficiency with MS Office

Responsibilities

• Ensure the accuracy and timeliness of processing enrollments and disenrollment in compliance with Medicare regulations and Zing Health policies.
• Analyze information to determine eligibility in accordance with CMS and Zing Health guidelines.
• Process daily applications and disenrollments in membership systems for CMS transmission.
• Maintain enrollment records and update eligibility in membership systems.
• Identify election periods based on beneficiary history and regulatory guidance.
• Support daily review and processing of CMS files and reports.
• Generate correspondence to outreach to members as needed.
• Adhere to regulatory updates and training materials.

Skills

Independence

Prioritization

Deadline-driven

Education

Bachelor's degree preferred

Tools

MS Office

Job description

COMPANY OVERVIEW

Zing Health is a tech-enabledinsurance company making Medicare Advantage the best it can be for those65-and-over. Zing Health has a community-based approach that recognizes theimportance of the social determinants of health in keeping individuals andcommunities healthy. Zing Health aims to return the physician and the member tothe center of the health care equation. Members receive individualized assistanceto make their transition to Zing Health as easy as possible. Zing Health offersmembers the ability to personalize their plans, access to facilities designedto help them better meet their healthcare needs and a dedicated care team. Formore information on Zing Health, visit www.myzinghealth.com.

SUMMARY DESCRIPTION:

Zing Health Plan is lookingfor an analytical, responsible, and strategic team player like you to join ourEnrollment Team! The Enrollment Specialist is responsible for performing dutiesrelated to enrollment of Medicare beneficiaries. The Enrollment Specialist isrequired to make eligibility determinations based on CMS (Part A/Part BEligibility) in accordance with the application election period guidelines.

ESSENTIAL FUNCTIONS:

• Ensure the accuracy andtimeliness of processing enrollments and disenrollment in compliance withinMedicare regulations and Zing policies and procedures
• Demonstrates the skills andability to analyze information to make appropriate decisions regardingeligibility in compliance with regulations and governance set forth by theCenters for Medicare Services (CMS) and Zing Health Inc.
• Process daily applicationsand disenrollment received via the various sources in the membership systemsfor daily transmission to CMS
• Processing new or maintenanceupdates to enrollment eligibility in the membership systems
• To accurately identifyappropriate election period based upon analysis of beneficiary/member historyand regulatory guidance
• Assist with daily reviews andprocessing of the Daily Transaction Reply Report (DTRR)
• Assist with tracking andoversight of CMS OEC, Auto and Facilitated web-based files
• Generate appropriatecorrespondence to outreach to members request, as necessary
• Performs root causeDescription analysis to determine issues related to member inquiry and orsystem errors
• Must adhere to and keep up todate with new regulations and guidance provided during training updates
• Attention to detail iscritical to the success of this position, with skills in customer orientation
• Accurately enter COB fortimely and accurate claims adjudication
• Assist mailroom withprocessing Return Mail
• Adhere to productivity, qualityand compliance expectation
  

QUALIFICATIONSAND REQUIREMENTS:

JOB REQUIREMENTS:

• Bachelor’s degree preferred
• Knowledge and thoroughunderstanding of managed care operations
• Ability to workindependently, set priorities and meet deadlines
• 1+ years’ experience with Medicarepreferred
• Strong knowledge/Proficiencywith MS Office