Remote Medicare Enrollment Specialist II

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

Job summary

HealthEdge Software, Inc. is seeking an Enrollment Specialist II to ensure accurate enrollment, billing, and data maintenance for members. You will research discrepancies, resolve CMS-related issues, and support reconciliation tasks across enrollment processes.

The role requires Medicare enrollment experience, familiarity with CMS interfaces, and the ability to document findings and mentor junior staff while maintaining strong collaboration across teams.

Qualifications

• 3-5 years of experience processing Medicare enrollment transactions.
• Strong knowledge of Medicare Advantage products and CMS enrollment guidelines; Medicaid experience a plus.
• Experience with CMS interfaces and systems for Medicare enrollment and billing functions.
• Ability to analyse enrollment reconciliation data and report SLAs, KPIs, and other operations reports.

Responsibilities

• Prepare, process, and maintain enrollment and disenrollment requests.
• Verify and maintain applicable eligibility requirements.
• Review CMS transactions and Medicaid eligibility verifications.
• Resolve enrollment system rejections based on regulatory and client guidelines.
• Reconcile membership reports as required by CMS.
• Mentor junior team members and collaborate on special projects.

Skills

Medicare enrollment processing

CMS interfaces experience

Data analysis and KPIs

Team collaboration

Strong work ethic

Education

High school diploma

Tools

CMS interfaces

CMS transaction files

Job description

HealthEdge Software, Inc. is seeking an Enrollment Specialist II to ensure accurate enrollment, billing, and data maintenance for members. You will research discrepancies, resolve CMS-related issues, and support reconciliation tasks across enrollment processes.

The role requires Medicare enrollment experience, familiarity with CMS interfaces, and the ability to document findings and mentor junior staff while maintaining strong collaboration across teams.