Remote Medicare Enrollment Specialist II

HealthEdge Software, Inc.; Northern (KY); Hybrid; 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

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.