Senior Enrollment Specialist

HealthEdge Software, Inc.; Northern (KY); Hybrid; USD 50,000 - 56,000; Full time

Job summary

HealthEdge Software, Inc. in the United States is hiring a Senior Enrollment Specialist to ensure accurate Medicare enrollment processing, including billing and member data maintenance.

You will verify eligibility, review CMS transactions, and resolve enrollment rejections while mentoring junior teammates and collaborating across teams. The role is remote with US-wide responsibilities.

Qualifications

• 5+ years of Medicare enrollment processing experience.
• Deep knowledge of Medicare Advantage and CMS files.
• Experience with CMS interfaces and enrollment/billing systems.
• Medicaid knowledge is a plus.
• Ability to analyze reconciliation data and report KPIs.
• Willingness to learn and team collaboration.

Responsibilities

• Prepare, process, and maintain enrollment/disenrollment requests.
• Verify eligibility requirements.
• Review CMS transactions and Medicaid eligibility.
• Resolve enrollment rejections per guidelines.
• Reconcile membership reports as required.
• Attend trainings and mentor juniors.

Skills

Medicare enrollment

CMS transactions

CMS interfaces

Data analysis

Education

High school diploma

Tools

CMS systems

Job description

Overview

Overview:

HealthEdge® offers AI-powered operational infrastructure for health insurance companies, guaranteeing an enduring financial edge in an increasingly competitive market. We're experiencing strong market momentum, with a growing number of health plans choosing HealthEdge to modernize their operations and compete more effectively. As we expand, we're investing in the people who power that growth, making this a pivotal moment to join us and shape the future of healthcare technology. Learn more at HealthEdge.com.

At UST HealthProof, you will join a fast paced, growing company in our mission to reshape the future of health insurance through significantly reducing administrative costs and building better healthcare experiences for our health plans customers and their members. By creating a modern, cloud based, Best-In-Class core administration ecosystem, we have made healthcare more affordable and helped our health plans operate more efficiently. Through member and provider touchpoints with less friction, we have created real impact for members.

UST HealthProof is run by leaders with strong health plan and technology backgrounds who have start-up mindsets and an environment of support where individual growth is nurtured. You will be supporting our proven core admin solutions and business process-as-a-service (BPaaS) operations to provide transparency, improve operational efficiency, and break down operational barriers to scale and drive strategic growth.

UST HealthProof is looking for a Senior Enrollment Specialist, reporting to the Enrollment Manager. The Senior Enrollment Specialist is responsible for ensuring accurate enrollment including billing and maintenance of member data by researching and resolving enrollment and billing discrepancies. The role is also responsible for reconciling and correcting enrollment-related issues by building case files that are sent to the CMS Contractor for approval and resolution.

As a Senior Enrollment Specialist at UST HealthProof, this is your opportunity to

• Be responsible for preparing, processing, and maintaining enrollment and disenrollment requests
• Be responsible to verify and maintain all applicable eligibility requirements
• Be responsible to review and process CMS transactions
• Be responsible to review Medicaid eligibility and complete verification processes
• Be responsible to resolve enrollment system rejections based on regulatory and client specified guidelines
• Be responsible to reconcile membership reports as required by CMS
• Be accountable to attend and successfully complete the trainings scheduled by the client and employer
• Mentor junior members of the team
• Collaborate with other team members on special projects; special projects can include process documentation development, training, quality reviews for the client(s), or any other project as determined by management
• Establish and maintain an appropriate level of communication with management to address issues and concerns and take preventive measures that ensure case accuracy and quality
• Participate in projects as assigned by management
• Perform other duties as assigned

You bring:

• 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
• Experience with CMS interfaces and systems for managing the Medicare Advantage enrollment and billing functions; Medicaid knowledge is a plus.
• Ability to analyse enrollment reconciliation data and report SLAs, KPIs, and other operations reports and present findings in a structured way
• High school degree required
• Willingness to learn
• Team collaborator
• Strong work ethic

For this role, we value:

• The ability to adapt quickly to a challenging environment
• A self-starter and quick learner
• Ability to collaborate

Geographic Responsibility: Remote, US

Type of Employment:Full-time, permanent

Work Environment:The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job:

• The employeeis occasionally required tomove around the office. Specific vision abilities required by this job include close vision, color vision, peripheral vision, depth perception, and ability to adjust focus.

• Work across multiple time zones in a hybrid or remote work environment.

• Long periodsof time sitting and/or standing in front of a computer using video technology.

• May require travel dependent on company needs.

The above statements are intended to describe the general nature and level of the job being performed by the individual(s) assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skillsrequired. HealthEdge reserves the right tomodify, add, or remove duties and to assign otherdutiesas necessary. In addition, reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position in compliance with the Americans with Disabilities Act of 1990.Candidates maybe requiredto go through a pre-employment criminal background check.

HealthEdge is an equal opportunity employer. We are committed to workforce diversity and actively encourage all qualified persons to seek employment with us, including, but not limited to, racial and ethnic minorities, women,veteransand persons with disabilities.

**The annual US base salary range for this positionis $50,000 to $56,000. This salary range may cover multiple career levels at HealthEdge. Final compensation will bedeterminedduring the interview process and is based on a combination of factors including, but not limited to,your skills, experience,qualificationsand education.