Senior Medicaid Enrollment & Data Integrity Specialist

HealthEdge; United States; A distancia; USD 50.000 - 56.000; Jornada completa

Descripción de la vacante

HealthEdge is hiring a Senior Enrollment Specialist to ensure accurate enrollment, billing, and maintenance of member data across CMS transactions. You will research discrepancies, build case files for CMS resolution, and maintain eligibility requirements.

The role also involves mentoring juniors and collaborating on client projects. The position supports remote US work and requires 5+ years in Medicare enrollment processing, with familiarity of Medicare Advantage and CMS systems.

Formación

• 5+ years of professional experience in processing Medicare enrollment transactions.
• Strong understanding of Medicare Advantage products and CMS transaction files.
• Experience with CMS interfaces and systems for enrollment and billing.
• Ability to analyse enrollment reconciliation data and report SLAs and KPIs.
• Willingness to learn and adapt to regulatory guidelines.

Responsabilidades

• Process enrollment and disenrollment requests; maintain member data.
• Verify eligibility and CMS transactions.
• Review Medicaid eligibility and related CMS processes.
• Reconcile membership reports and resolve discrepancies as required by CMS.
• Collaborate with team on special projects and process documentation.
• Mentor junior team members and participate in trainings.

Conocimientos

Medicare enrollment processing

CMS interfaces

CMS guidelines

Data analysis

Team collaboration

Willingness to learn

Educación

High school diploma

Herramientas

CMS systems

Descripción del empleo

HealthEdge is hiring a Senior Enrollment Specialist to ensure accurate enrollment, billing, and maintenance of member data across CMS transactions. You will research discrepancies, build case files for CMS resolution, and maintain eligibility requirements.

The role also involves mentoring juniors and collaborating on client projects. The position supports remote US work and requires 5+ years in Medicare enrollment processing, with familiarity of Medicare Advantage and CMS systems.