Enrollment Specialist

Job Description

Job Description

POSITION SUMMARY

Responsible for the processing of new enrollment applications and updating current member profile changes in accordance with CMS and State regulations.

ESSENTIAL DUTIES & RESPONSIBILITIES

• Handles receiving, controlling, and processing enrollment and disenrollment elections from Medicare beneficiaries, as well as any required updates to a member record.

• Audits data entered into the plans internal systems to ensure data integrity and quality.

• Uses judgment and informed decision-making to determine appropriate actions on elections and in handling discrepancies.

• Transmits election information to CMS within specified timeframes and according to CMS regulations.

• Ensures appropriate letters are sent to members within CMS timeframes.

• Conducts outbound calls to confirm and verify mailing addresses, permanent residency.

• Sorts returned mail and prepares mail with corrected addresses.

• Analyzes and interprets out of area indicator reports submitted by CMS and determine action to be taken.

• Places materials into storage receptacles, such as file cabinets, boxes, bins, or drawers, according to classification and identification information.

• Reads and scans all incoming materials to determine how and where they should be classified or filed.

• Sorts or classifies information according to guidelines, such as content, purpose, user criteria, or chronological, alphabetical, or numerical order.

• Eliminates outdated or unnecessary materials, destroying them or transferring them to inactive storage, according to file maintenance guidelines or legal requirements.

• Performs periodic inspections of materials or files to ensure correct placement, legibility, and proper condition.

• Input data, such as file numbers, new or updated information, or document information codes into computer systems to support document and information retrieval.

• Communicates effectively with other professional and support staff in order to achieve positive customer outcomes.

• Promotes and contributes to a positive, problem-solving environment.

• Assists customers, family members and others with concern and empathy; respect their confidentiality and privacy and communicate with them in a courteous and respectful manner.

• Complies with company policies and procedures and maintains confidentiality of customer medical records in accordance with state and federal laws.

• Ensures compliance with all HIPAA, OSHA, and other federal, state, and local regulations.

• Participates in meetings, training and in-service education, as required.

• Performs other duties as assigned.

SUPERVISORY RESPONSIBILITY

None

QUALIFICATIONS & EDUCATION

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• High school graduate or equivalent and one (1) year Medicare, Medicaid, managed care or other health/insurance related experience; or equivalent combination of education and experience.

• Data entry skills a must

• Excellent organizational skills, customer service skills, listening, interpersonal, verbal and written communication skills with individuals at all levels of the organization

• Excellent computer knowledge is required, including proficient knowledge of Microsoft Office

• Familiarity with healthcare laws, regulations, and standards

• Working knowledge of the Privacy and Security Health Insurance Portability and Accountability Act (HIPAA) regulations

• Ability to continually display a positive attitude and follow directions

• Ability to multi-task, prioritize, carry out tasks thoroughly, and meet deadlines

• Must be patient in dealing with an elderly population and sympathetic to hearing or vision deficiencies

• Ability to work effectively independently and in a team environment

• Ability to read, analyze, and interpret technical procedures or governmental regulations

• Ability to write reports, business correspondence, and procedure manuals

• Ability to effectively present information and respond to questions from groups of managers, clients, customers and the general public

• Ability to calculate figures and amounts, such as discounts, interest, commissions, proportions, percentages, area and volume

• Ability to define problems, collect data, establish facts, and draw valid conclusions

• Strong decision-making, analytical skills

• Must be self-motivated, organized and have excellent prioritization skills

• Must be able to work well under stressful conditions

• Must be able to work in a fast paced environment

• Fluency in Spanish and English required

WORKING CONDITIONS

.

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• The noise level in the work environment is usually moderate.

• Fast pace office environment.

• Highly regulated environment.

• Time frames to handle issues are in accordance with CMS time frames.

• Interacts with customers, family members, staff, visitors, government agencies, etc., under a variety of conditions and circumstances.

This work requires the following physical activities: climbing, bending, stooping, kneeling, twisting, reaching, sitting, standing, walking, lifting, finger dexterity, grasping, repetitive motions, talking, hearing and visual acuity. The work is performed indoors. Sits, stands, bends, lift, and moves intermittently during working hours.

Work schedule is approximate and hours/days may change based on company needs. All full-time employees are required to complete forty (40) hours per week as scheduled, including on weekends and holidays as needed.

PHYSICAL DEMANDS

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. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The employee must be able to frequently lift up to 50 pounds and occasionally lift and/or move up to 25 pounds. While performing the duties of this job, the employee is regularly required to talk or hear. The employee is frequently required to stand and walk. The employee is occasionally required to use hands to finger, handle, or feel; reach with hands and arms; climb or balance and stoop, kneel, crouch, or crawl. Specific vision abilities required to this job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.

PERFORMANCE MEASUREMENTS

• Duties accomplished at the end of the day/month

• Attendance/Punctuality

• Compliance with Company Regulations

• Safety and Security

• Accuracy Rate

This Job Description may be modified at any time at the discretion of the employer as business operation may deem necessary. This does not constitute an employment agreement and may not include all duties.

The above statements are intended to describe the general nature and level of work being performed by individuals ass