Medicare Enrollment Specialist

LHC Group; Eden Prairie (MN); Remote; USD 70,000 - 85,000; Full time

Job summary

A leading organization in healthcare is seeking a Medicare Enrollment Specialist to manage enrollment functions for PACE participants. This remote role requires strong experience in health plan operations and knowledge of CMS systems, ensuring compliance and effective communication with various stakeholders. The specialist will also handle data validation, reporting, and resolution of any enrollment issues affecting participant eligibility.

Benefits

403(b) Retirement Plan

Career scholarships

Continuing career education and leadership programs

Medical, Dental and Vision Insurance

Paid Time Off (Vacation, Holiday & Sick Days)

NetSpend – Get paid early: Tap into 50% of your earnings before payday

Qualifications

• Minimum two years of experience in health plan operations within PACE or managed care.
• Working knowledge of CMS systems including MARx, EDV, MMR, and Gentran.
• Familiarity with Medicare enrollment policies and regulatory requirements.

Responsibilities

• Manage backend Medicare enrollment functions for PACE participants.
• Ensure timely, accurate, and compliant enrollment data within CMS systems.
• Prepare and submit retroactive enrollment and disenrollment packages.

Skills

Attention to detail

Communication

Problem-solving

Organizational skills

Data analysis

Education

Associate’s degree or higher in Healthcare Administration, Business, or related field

Tools

Microsoft Excel

Job description

Volunteers of America National Services is seeking a Medicare Enrollment Specialist to join our team in support of Medicare enrollment functions for PACE participants across all VOANS PACE organizations.

Schedule: Monday-Friday 8:00 AM-5:00 PM (Fully Remote)

Salary: $70,000-$85,000 (Based on Experience)

About the Job: Manage backend Medicare enrollment functions for PACE Participants across all VOANS PACE organizations. This role ensures timely, accurate and compliant enrollment and disenrollment data within CMS systems, ensures alignment with internal records, oversees related reporting and reconciliation processes, and supports resolution of enrollment issues that affect participant classification, eligibility, and program payments.

Benefit Highlights:

• 403(b) Retirement Plan
• Career scholarships;
• Continuing career education and leadership programs;
• Medical, Dental and Vision Insurance
• Paid Time Off (Vacation, Holiday & Sick Days)
• NetSpend – Get paid early: Tap into 50% of your earnings before payday

Essentials:

• Monitor and resolve CMS Daily Transaction Reply Reports (DTRR), identifying actionable items and addressing issues.
• Review Monthly Membership Reports (MMR); complete data validation and payment attestations. Manage submission to PDAC.
• Track Plan Benefit Package changes and ensure accurate updates to MARx. Track and log Medicare rates from MARx for newly enrolled participants each month to support accurate financial reporting and reconciliation.
• Submit monthly Medicare enrollment and disenrollment transactions to CMS, validating accuracy of paperwork and ensuring alignment of internal records with information in MARx.
• Monitor for members aging into Medicare and gaining Medicare eligibility outside standard aging-in process.
• Understand, identify and maintain paperwork needed for existing members as their eligibility status changes based on scenario. Examples include but are not limited to: a new enrollment agreement for a member going from Medicare only to Dual; Perspective Medicare Entitlement (PME) letter for members gaining Medicare a minimum of 60 days prior to gaining eligibility (or Retroactive Medicare Entitlement (RME) for notification not done timely).
• Prepare and submit retroactive enrollment, disenrollment, and reinstatement packages to Reed and Associates.
• Maintain communication with CMS account representatives regarding unresolved participant issues.
• Submit responses to Enrollment Data Validation (EDV) requests, analyze EDV response data, and manage dispute resolution.
• Download and analyze Gentran reports and other data files used in the CMS enrollment process.
• Submit and maintain accurate 4Rx data in MARx to ensure accurate Financial Information Reporting (FIR) and prevent errors.
• Assist with FIR and PDE rejection resolution with the Pharmacy Benefit Manager (PBM).
• Monitor CMS Late Enrollment Penalty (LEP) reports and track LEP status for Medicare-only participants to ensure accurate billing and compliance with CMS requirements.
• Monitor hospice status changes on DTRR reports and coordinate appropriate disenrollments or corrections, including re-enrollment actions when hospice designations are inaccurate.
• Review monthly and annual COB/MSP reports to ensure participant records are accurate for claims processing, submitting corrections through ECRS when discrepancies are identified.
• Generate and submit monthly files to Risk Adjustment vendor, including but not limited to Eligibility File, MAO004, MMR, MOR, MSPCOBMA, PTDMODD.
• Generate and submit monthly files to PDAC, including but not limited to PTDMODR, PTDMODD, HCCMODD, HCCMODR, MAO004, MONMEMD.
• Oversee ID card processes, including template management, printing, and reprinting for active participants.
• Coordinate with Accounts Receivable team to ensure enrollment records support proper participant classification and payment accuracy.
• Analyze monthly Accounts Receivable aging reports to identify and address payment discrepancies related to retroactive enrollment issues.
• Collaborate with PACE Center staff and state agencies as needed, based on state-specific Medicaid or dual enrollment processes.
• Collaborate with internal departments to resolve enrollment-related payment issues and ensure alignment across systems.
• Monitor CMS guidance for updates related to enrollment policies, file formats, and report layouts to ensure ongoing compliance and system alignment.
• Perform other duties or special projects as assigned.

Required Qualifications:

• Associate’s degree or higher in Healthcare Administration, Business, or related field required.
• Minimum two years of experience in health plan operations within PACE or a managed care environment. Experience in Medicare enrollment operations preferred.
• Working knowledge of CMS systems and reports including MARx, EDV, MMR, and Gentran.
• Familiarity with Medicare enrollment policies and regulatory requirements.
• Proficiency in analyzing enrollment and payment files, with strong attention to detail.
• Excellent organizational skills and the ability to manage multiple deadlines.
• Strong communication and problem-solving skills.
• Proficiency in Microsoft Excel and data analysis tools.
• Ability to communicate and work effectively with various levels of facility and corporate staff and maintain effective relationships with CMS, state agencies, and vendors.

At VOANS, we celebrate sharing, encouraging and embracing diversity. Equal employment opportunities are available to all without regard to race, color, religion, sex, pregnancy, national origin, age, physical and mental disability, marital status, parental status, sexual orientation, gender identity, gender expression, genetic information, military and veteran status, and any other characteristic protected by applicable law. We believe that blending individual strengths and unique personal differences nurtures and supports our organizations’ shared commitment to our mission and creates an inclusive and diverse environment where everyone feels valued and has the opportunity to do their personal best

Equal Opportunity Employer
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