Medicare Member Enrollment Specialist - 100% remote

Ram Technologies; Philadelphia (Philadelphia County); Remote; USD 25,000 - 39,000; Full time

Benefits offered by this job

Remote work

Health insurance

Dental insurance

Vision insurance

401k match

Paid vacation

Life insurance

AD&D

Disability insurance

HSA

FSA

Tuition reimbursement

Parental Leave

Job summary

RAM Health is seeking an Enrollment Specialist to process Medicare Advantage enrollment applications, COB data updates, and member maintenance in a 100% remote role. You will handle daily transaction reporting, CMS file reconciliation, and member communications with accuracy and speed.

Ideal candidates support CMS guidance, HIPAA requirements, and use MS Word and Excel to document actions. Strong attention to detail and clear written/oral communication are essential for success in this role.

Qualifications

• High school diploma required.
• Experience with Medicare Advantage enrollment processes preferred.
• Familiarity with CMS guidance and PCUG is a plus.
• Strong attention to detail and clear written and verbal communication required.

Responsibilities

• Process enrollment applications and disenrollments.
• Update member records and COB data as needed.
• Perform monthly enrollment reconciliation.
• Generate CMS correspondence upon request.
• Meet production and quality targets.
• Identify opportunities to improve efficiency within processes.

Skills

Attention to detail

Written communication

Oral communication

CMS MARx familiarity

Education

High School Diploma

Tools

MS Word

MS Excel

Job description

At RAM Health, our mission is to simplify the complexities of healthcare administration through innovative, technology-driven solutions. With a focus on changing the industry one plan at a time, we drive continuous innovation to help government-sponsored health plans improve performance and quality while reducing costs.

The Enrollment Specialist will be required to process various enrollment transactions including enrollment applications, Daily Transaction Reply Reporting, member maintenance, monthly reconciliation and capture member COB data by utilizing documented business rules and processes while adhering to Center for Medicare Services (CMS) guidance and Client rules. The specialist must have excellent analytical skills, along with keen attention to detail and good written and oral communication abilities. This is a 100% remote position.

Role and Responsibilities

• Perform tasks associated with Medicare Advantage member record updates including, but not limited to, processing enrollment applications, disenrollments requests, address changes, ACH updates, member demographic updates and others as needed.
• Process transactions requiring manual intervention from various sources of CMS files and reconciliation reporting.
• Generate CMS required correspondence to a member or upon the member's request.
• Perform the monthly reconciliation of the member enrollment data to the CMS system of record.
• Accurately enter member Coordination of Benefits (COB) data.
• Meet established production and quality standards.
• Identify opportunities to improve efficiency within assigned processes.
• Complete special projects as assigned.
  

Industry Experience

• 1-3 years in healthcare industry experience working in Medicare Advantage, Managed Medicaid, or working with an industry competitor processing enrollment applications and member status changes.
• Experience working with the Center for Medicare Services’ (CMS’s) Medicare Advantage & Prescription Drug System (MARx).
• Experience in a Business Process as a Service (BPaaS) setting or similar environment.

Skills & Knowledge

• Candidate should have experience working in a production environment and the ability to meet performance standards.
• Attention to detail and the ability to apply documented procedures to achieve desired outcomes are also required.
• Familiarity with the Medicare Advantage and Part D Enrollment and Disenrollment Guidance (formerly Chapters 2 & 3) and the CMS Plan Communications User Guide (PCUG), preferred.
• MS Word and MS Excel, good interpersonal skills, written and oral communication abilities a must.

Education

• A High School Diploma is required.

Compensation and Benefits

• Competitive hourly rate commensurate with experience
• 100% remote work culture
• Health, dental & vision insurance
• 3 weeks of vacation
• Vacation and holiday pay
• Traditional and ROTH 401k with company match
• Company paid life insurance, AD&D, and long-term disability coverage
• HSA and FSA accounts
• Tuition Reimbursement
• Parental Leave

Compliance: All employees shall comply with company policies, including those related to security and privacy, as well as with applicable laws and regulations such as the Health Insurance Portability and Accountability Act (HIPAA), the Health Information Technology for Economic and Clinical Health (HITECH) Act, and other relevant federal and state regulations.

Data Protection: Employees are responsible for safeguarding protected health information (PHI) and personally identifiable information (PII) in accordance with company policies and HIPAA regulations. This includes ensuring that all data is accessed, processed, stored, and transmitted securely.