Remote Medicare Enrollment Validation Specialist

Randstad USA; Pawtucket (RI); À distance; USD 26 000 - 27 000; Plein temps

Résumé du poste

Randstad USA is seeking an Enrollment Validation Specialist to join a member-first, collaborative team supporting Medicare alignment and provider services. This remote role offers a daytime schedule with no weekend shifts and requires meticulous data verification across healthcare systems.

You will validate PCP assignments, handle high-volume inquiries, and ensure CMS compliance while using MS Excel. The ideal candidate has 1+ year in healthcare eligibility and proficiency with MS Office.

Qualifications

• High School Diploma or GED required.
• 1+ years of experience in healthcare eligibility, enrollment, provider networks, or CMS guidelines.
• Working knowledge of healthcare billing/claims platforms (e.g., QNXT or similar).
• Comfortable conducting outbound verification calls and entering high-volume data accurately.
• Proficient in Microsoft Office (Excel, Outlook, Word).

Responsabilités

• Research member enrollment data across multiple healthcare systems and resolve discrepancies.
• Validate PCP assignments and process timely updates for Medicare members.
• Conduct outbound outreach to obtain Verification of Chronic Conditions (CSNP).
• Track and resolve high-volume eligibility inquiries and state agency updates using MS Excel.
• Maintain strict accuracy, turnaround times, and CMS compliance metrics.

Connaissances

healthcare eligibility

enrollment

provider networks

Formation

High School Diploma or GED

Outils

QNXT

Description du poste

Randstad USA is seeking an Enrollment Validation Specialist to join a member-first, collaborative team supporting Medicare alignment and provider services. This remote role offers a daytime schedule with no weekend shifts and requires meticulous data verification across healthcare systems.

You will validate PCP assignments, handle high-volume inquiries, and ensure CMS compliance while using MS Excel. The ideal candidate has 1+ year in healthcare eligibility and proficiency with MS Office.