Medicare Enrollment Specialist

Peak Health; Lubbock (TX); Presencial; USD 22.000 - 30.000; Jornada completa

Descripción de la vacante

PHH Peak Health Holdings is seeking a Medicare Enrollment Specialist to join our enrollment team in a role reporting to the Enrollment Manager. You will review and process member enrollment forms, determine eligibility, and perform data entry with high accuracy to support Peak Health Plan Suite operations.

Responsibilities include resolving enrollment issues, maintaining records, and delivering trainings. The role emphasizes quality control, CMS tool familiarity, and excellent communication with

Formación

• High School diploma or equivalent; plus data entry and customer service experience.
• Bachelor's degree or higher preferred; related healthcare education valued.
• Experience with Medicare enrollment processing and eligibility review.

Responsabilidades

• Verify accuracy and completeness of member enrollment forms.
• Resolve enrollment issues to ensure smooth member experience.
• Maintain Medicare enrollment records and update as needed.
• Meet production and quality standards; manage Workqueues.
• Communicate effectively with internal and external staff.
• Coordinate benefits (COB) on member records.
• Develop and deliver trainings for the department.

Conocimientos

Medicare enrollment processes

Data entry accuracy

Customer service

Attention to detail

Communication skills

Educación

Bachelor's degree

Associate Degree in healthcare field

High School diploma or equivalent

Herramientas

EPIC

Microsoft Office

MARx CMS

Descripción del empleo

Welcome! We’re excited you’re considering an opportunity with us! Below, you’ll find other important information about this position. Come join our Peak Health team at WVU Medicine as a Medicare Enrollment Specialist, contributing to the foundation for an innovative, new health plan. This position will report to the Enrollment Manager, playing a unique and important role in our mission to change healthcare for the better.

Experience in Medicare and critical thinking skills will help the organization build an effective and efficient enrollment team. The enrollment team will review, execute, and oversee the processing of member enrollment application information for Peak Health’s Plan Suite.

The Medicare Enrollment Specialist will analyze and process enrollment forms, checking for validity, completion, and accuracy. Ability to determine whether to enroll, outreach, or reject applications while following organizational policies and procedures is a must. This job reviews and evaluates all documents for quality control for final entry of member enrollment forms.

Minimum Qualifications

Education, Certification, and/or Licensure

• High School diploma or equivalent AND Two (2) year of experience working with medical or institutional data entry AND Two (2) year of customer service experience
• High School diploma or equivalent AND One (1) year of Medicare eligibility and Medicare Enrollment processing experience
• Bachelor's degree

Preferred Qualifications

Education, Certification, and/or Licensure

• Associate Degree, or greater, in related healthcare field.

Experience

• Three (3) to five (5) years of Medicare Enrollment processing and customer service experience.
• Two (2) years of experience with Medicare elections, transaction codes, and reconciliation operations.
• Two (2) years managing late enrollment penalty (LEP) for MAPD enrollees.
• Familiarity with navigating CMS tools and resources, particularly the MARx website.
• At least one (1) year of experience with system/user acceptance testing.
• At least one (1) year of experience with developing and delivering trainings.

Core Duties and Responsibilities

• Determine accuracy and completions of member form information. Entry/verifies form data.
• Resolves enrollment issues to assure efficient and seamless member experience.
• Maintains Medicare member enrollment records annually, indicating changes, updates, and outreach as required.
• Meets all production and quality standards, maintaining Workqueues according to department standards.
• Effectively communicates with internal and external staff.
• Elevates issues to next level of supervision, as appropriate.
• Ensures accuracy of data entered and record maintenance.
• Attends all required training classes, demonstrating proficiency and ability to learn.
• Manages coordination of benefits (COB) on member records.
• Develops and Delivers department trainings to new hires.
• Participates in system testing for any development rollouts.
• Participates in department planning to ensure a successful Open Enrollment.
• Other duties as deemed appropriate by the Management Team.
• Processes SNP applications, verifying eligibility, including but not limited to Dual-Entitlement and residence within the service area.

Physical Requirements

• Ability to sit for extended periods of time.

Working Environment

• Standard office environment with electrical equipment (i.e., telephone, personal computer, copier, fax machines, etc.)
• Computer Software/Systems include but not limited to Microsoft Office Professional Suite (Outlook, Word, Excel, Access), Internet Explorer, and EPIC.

Skills and Abilities

• Familiarity with Medical insurance enrollment processes.
• Working Knowledge of administrative and clerical procedures and systems such as word processing and managing files and records.
• Ability to take direction and to navigate through multiple systems simultaneously.
• Excellent written and oral communication, customer service, interpersonal skills, and telephone etiquette skills.
• Ability to solve problems with predefined methods and guidelines to drive improved efficiencies and customer satisfaction.
• Requires exceptional attention to detail, the ability to be organized and to be able to perform multiple tasks simultaneously.

Additional Job Description

Scheduled Weekly Hours: 40

Exempt/Non-Exempt: United States of America (Non-Exempt)

Shift: United States of America (Non-Exempt)

Company: PHH Peak Health Holdings

Cost Center: 2910 PHH Enrollment