Medicare Enrollment Specialist II

HealthEdge Software, Inc.; Northern (KY); On-site; USD 40,000 - 44,000; Full time

Job summary

HealthEdge is hiring an Enrollment Specialist II to ensure accurate enrollment, billing, and maintenance of member data. You will research discrepancies, resolve CMS-related issues, and prepare case files for CMS contractor approval.

The role requires Medicare enrollment experience, CMS system familiarity, and strong attention to detail, with remote US work options and opportunities to mentor peers.

Qualifications

• 2 years of professional Medicare enrollment processing experience.
• Solid understanding of Medicare Advantage and CMS guidelines.
• Experience with CMS interfaces and systems for enrollment and billing.
• Ability to analyze enrollment reconciliation data and report on KPIs and SLAs.

Responsibilities

• Prepare, process, and maintain enrollment and disenrollment requests.
• Verify and maintain applicable eligibility requirements.
• Review and process CMS transactions.
• Review Medicaid eligibility and verification processes as needed.
• Resolve enrollment system rejections based on regulatory and client guidelines.
• Reconcile membership reports as required by CMS.
• Attend trainings and mentor junior team members.
• Collaborate on special projects and communicate with management to ensure case accuracy.

Skills

Medicare enrollment processing

CMS transaction files

CMS interfaces experience

Enrollment reconciliation data

Team collaboration

Willingness to learn

Strong work ethic

Regulatory compliance

Education

High school diploma or GED

Job description

Overview

HealthEdge® offers AI-powered operational infrastructure for health insurance companies, guaranteeing an enduring financial edge in an increasingly competitive market. We're experiencing strong market momentum, with a growing number of health plans choosing HealthEdge to modernize their operations and compete more effectively. As we expand, we're investing in the people who power that growth, making this a pivotal moment to join us and shape the future of healthcare technology. Learn more at HealthEdge.com.

At HealthProof, you will join a fast paced, growing company in our mission to reshape the future of health insurance through significantly reducing administrative costs and building better healthcare experiences for our health plans customers and their members. By creating a modern, cloud based, Best-In-Class core administration ecosystem, we have made healthcare more affordable and helped our health plans operate more efficiently. Through member and provider touchpoints with less friction, we have created real impact for members.

HealthProof is run by leaders with strong health plan and technology backgrounds who have start-up mindsets and an environment of support where individual growth is nurtured. You will be supporting our proven core admin solutions and business process-as-a-service (BPaaS) operations to provide transparency, improve operational efficiency, and break down operational barriers to scale and drive strategic growth.

HealthProof is looking for an Enrollment Specialist II, reporting to the Enrollment Manager. The Enrollment Specialist II is responsible for ensuring accurate enrollment including billing and maintenance of member data by researching and resolving enrollment and billing discrepancies. The role is also responsible for reconciling and correcting enrollment-related issues by building case files that are sent to the CMS Contractor for approval and resolution.

As an Enrollment Specialist II at HealthProof, this is your opportunity to

• Be responsible for preparing, processing, and maintaining enrollment and disenrollment requests
• Be responsible to verify and maintain all applicable eligibility requirements
• Be responsible to review and process CMS transactions
• Be responsible for reviewing Medicaid eligibility and completing verification processes
• Be responsible to resolve enrollment system rejections based on regulatory and client specified guidelines
• Be responsible for reconciling membership reports as required by CMS
• Be accountable to attend and successfully complete the trainings scheduled by the client and employer
• Mentor junior members of the team
• Collaborate with other team members on special projects; special projects can include process documentation development, training, quality reviews for the client(s), or any other project as determined by management
• Establish and maintain an appropriate level of communication with management to address issues and concerns and take preventive measures that ensure case accuracy and quality
• Participate in projects as assigned by management
• Perform other duties as assigned

You bring:

• High school diploma or GED required
• 2 years professional experience in processing Medicare enrollment transactions
• A thorough understanding of Medicare Advantage products, CMS transaction files, and the corresponding enrollment-related guidelines; Medicaid enrollment experience a plus
• Experience with CMS interfaces and systems for managing the Medicare Advantage enrollment and billing functions
• Ability to analyze enrollment reconciliation data and report SLAs, KPIs, and other operations reports and present findings in a structured way
• Willingness to learn
• Team collaborator
• Strong work ethic

For this role, we value:

• The ability to adapt quickly to a challenging environment
• A self-starter and quick learner
• Ability to collaborate

Geographic Responsibility: Remote, US

Type of Employment:Full-time, permanent

Work Environment:The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job:

• The employeeis occasionally required tomove around the office. Specific vision abilities required by this job include close vision, color vision, peripheral vision, depth perception, and ability to adjust focus.

• Work across multiple time zones in a hybrid or remote work environment.

• Long periodsof time sitting and/or standing in front of a computer using video technology.

• May require travel dependent on company needs.

The above statements are intended to describe the general nature and level of the job being performed by the individual(s) assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skillsrequired. HealthEdge reserves the right tomodify, add, or remove duties and to assign otherdutiesas necessary. In addition, reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position in compliance with the Americans with Disabilities Act of 1990.Candidates maybe requiredto go through a pre-employment criminal background check.

HealthEdge is an equal opportunity employer. We are committed to workforce diversity and actively encourage all qualified persons to seek employment with us, including, but not limited to, racial and ethnic minorities, women,veteransand persons with disabilities.

#LI-Remote

** The annual US base salary range for this position is $40,000 to $44,000. This salary range may cover multiple career levels at HealthEdge. Final compensation will bedeterminedduring the interview process and is based on a combination of factors including, but not limited to,your skills, experience,qualificationsand education.