Medicare Advantage Enrollment Specialist

Veterans in Healthcare; Los Angeles (CA); On-site; USD 3,248,380 - 4,552,968; Full time

Job summary

Veterans in Healthcare in Los Angeles, CA, is seeking a Medicare Advantage Enrollment Representative to review and submit enrollment requests and maintain accurate acknowledgments for members. You will collaborate with multiple departments to resolve issues and use KPIs to monitor performance and report on service levels.

The role emphasizes ensuring timely CMS–Medicare submissions, validating Medicaid aid codes, and driving continuous process improvements to enhance member experience and

Responsibilities

• Review and submit Enrollment requests received as well as maintaining accuracy and timeliness of acknowledgment notices to members
• Maintain open lines of communication with various departments to resolve member issues and implement ADHOC resolutions to sustain quality member care
• Use Key Performance Indicator’s (KPIs) to identify trends and risks; manage service and Operating Level Agreement metrics/reporting and present findings
• Review Medicaid Aid codes and their corresponding Medicaid level and interpretation for department processes.
• Ensure quality and compliance to meet applicable guidelines; ensure timely, accurate and complete submissions to CMS – Medicare
• Identifies continuous improvement initiatives to streamline processes, reduce member complaints and improve the overall member experience
• Ensure that prospective enrollees are appropriately screened to meet eligibility requirements within regulatory timelines
• Work closely with the Sales and Compliance teams to ensure timely submissions and resolution of eligibility issues, as well as departmental goals and quality goals are met
• Ensure the required member mailings are sent in a timely fashion

Job description

Veterans in Healthcare in Los Angeles, CA, is seeking a Medicare Advantage Enrollment Representative to review and submit enrollment requests and maintain accurate acknowledgments for members. You will collaborate with multiple departments to resolve issues and use KPIs to monitor performance and report on service levels.

The role emphasizes ensuring timely CMS–Medicare submissions, validating Medicaid aid codes, and driving continuous process improvements to enhance member experience and