Remote Medicare Enrollment Specialist II

The Blue Venture Fund; United States; On-site; USD 40,000 - 44,000; Full time

Job summary

HealthEdge is seeking an Enrollment Specialist II to ensure accurate enrollment, billing, and maintenance of member data by resolving discrepancies and coordinating with CMS contractors. The role emphasizes data accuracy, CMS transaction handling, and adherence to enrollment guidelines.

Remote-friendly, you will collaborate with the enrollment team to review Medicaid eligibility, complete verifications, and mentor junior members while supporting process improvements and timely reporting across

Qualifications

• 3-5 years of professional experience in processing Medicare enrollment transactions.
• 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
• Team collaborator
• Strong work ethic

Responsibilities

• Prepare, process, and maintain enrollment and disenrollment requests
• Verify and maintain applicable eligibility requirements
• Review and process CMS transactions
• Review Medicaid eligibility and complete verification processes
• Resolve enrollment system rejections based on regulatory and client guidelines
• Reconcile membership reports as required by CMS
• Attend and complete trainings scheduled by client and employer
• Mentor junior team members
• Collaborate on special projects including process documentation, training, quality reviews
• Maintain communication with management to address issues and ensure case accuracy and quality
• Participate in projects as assigned
• Perform other duties as assigned

Skills

Medicare enrollment

CMS interfaces

Data analysis

Team player

Attention to detail

Willingness to learn

CMS transactions

Medicare Advantage

Medicaid experience

Education

High School Diploma

Job description

HealthEdge is seeking an Enrollment Specialist II to ensure accurate enrollment, billing, and maintenance of member data by resolving discrepancies and coordinating with CMS contractors. The role emphasizes data accuracy, CMS transaction handling, and adherence to enrollment guidelines.

Remote-friendly, you will collaborate with the enrollment team to review Medicaid eligibility, complete verifications, and mentor junior members while supporting process improvements and timely reporting across