Remote Enrollment Specialist II — Medicare & CMS

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

Job summary

HealthEdge is seeking an Enrollment Specialist II to ensure accurate enrollment, billing, and member data maintenance. You will research discrepancies, build case files for CMS approvals, and collaborate with the team on projects.

This role requires Medicare enrollment experience and familiarity with CMS interfaces. We offer remote work across the US, a full-time permanent position, and a base salary range of $40,000 to $44,000 annually.

Qualifications

• 3–5 years of professional experience processing Medicare enrollment transactions.
• Thorough understanding of Medicare Advantage products, CMS transaction files, and enrollment guidelines; Medicaid enrollment a plus.
• Experience with CMS interfaces and systems for Medicare Advantage enrollment and billing.
• Ability to analyze enrollment reconciliation data and report SLAs, KPIs, and other operations reports; present findings clearly.
• Willingness to learn; team collaborator; strong work ethic.

Responsibilities

• Prepare, process, and maintain enrollment and disenrollment requests.
• Verify and maintain all applicable eligibility requirements.
• Review and process CMS transactions and Medicaid eligibility as applicable.
• Resolve enrollment system rejections per regulatory and client guidelines.
• Reconcile membership reports as required by CMS.
• Mentor junior team members.
• Collaborate on special projects and documentation improvements.
• Communicate with management to address issues and ensure accuracy.

Skills

Medicare enrollment experience

CMS interfaces knowledge

Enrollment reconciliation analysis

Willingness to learn

Team collaboration

Education

High school diploma

Tools

CMS systems

Job description

HealthEdge is seeking an Enrollment Specialist II to ensure accurate enrollment, billing, and member data maintenance. You will research discrepancies, build case files for CMS approvals, and collaborate with the team on projects.

This role requires Medicare enrollment experience and familiarity with CMS interfaces. We offer remote work across the US, a full-time permanent position, and a base salary range of $40,000 to $44,000 annually.