Enrollment Specialist

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Doral, FL, US

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

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 time frames and according to CMS regulations.

Ensures appropriate letters are sent to members within CMS time frames.

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Eliminates outdated or unnecessary materials, destroying them or transferring them to inactive storage, according to file maintenance guidelines or legal requirements.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

None

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.

Excellent organizational skills, c ustomer 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,…