Remote Medicare Enrollment Specialist II

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 including billing and maintenance of member data. The role involves researching and resolving enrollment discrepancies and building case files for CMS approval and resolution. Remote US work with a focus on Medicare enrollment excellence.

The candidate will verify eligibility, process CMS transactions, and mentor junior teammates while collaborating on client projects and trainings.

Qualifications

• 3-5 years of 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 analyse enrollment reconciliation data and report SLAs, KPIs, and other operations reports and present findings in a structured way.
• Willingness to learn and team collaborator.

Responsibilities

• Prepare, process, and maintain enrollment and disenrollment requests.
• Verify and maintain all applicable eligibility requirements.
• Review and process CMS transactions.
• Review Medicaid eligibility and verification processes.
• Resolve enrollment system rejections based on regulatory and client specified guidelines.
• Reconcile membership reports as required by CMS.
• Attend and successfully complete trainings scheduled by the client and employer.
• Mentor junior members of the team.
• Collaborate on special projects; documentation, training, QA, or other projects as determined by management.
• Maintain communication with management to address issues and take preventive measures for case accuracy and quality.
• Participate in projects as assigned by management.
• Perform other duties as assigned.

Skills

Medicare enrollment processing

CMS interfaces familiarity

Data analysis & reporting

Team collaboration

Willingness to learn

Education

High school degree

Tools

CMS systems

Job description

HealthEdge is seeking an Enrollment Specialist II to ensure accurate enrollment including billing and maintenance of member data. The role involves researching and resolving enrollment discrepancies and building case files for CMS approval and resolution. Remote US work with a focus on Medicare enrollment excellence.

The candidate will verify eligibility, process CMS transactions, and mentor junior teammates while collaborating on client projects and trainings.