Enrollment Specialist- MA Plan

at  Provider Partners Health Plan

SUMMARY/OBJECTIVE

Provider Partners Health Plan is a rapidly growing Medicare Advantage plan whose goal is to deliver excellent, compassionate, and personalized health care for seniors with a special focus on those individuals whose health status requires them to reside in a long-term care facility or nursing home. We are seeking a candidate with strong organizational skills and a keen attention to detail to assist with all enrollment related functions. Experience with Medicare Advantage is highly desirable.
The candidate will pick up once a prospective member signs an enrollment form and indicates their intent to become a member of the plan. This position is responsible for coordination and maintenance of member enrollment information; enrollment, disenrollment and cancellation transactions, eligibility verification, LIS, hospice, and other status updates and ensuring member assignment to a participating PCP. This position also requires that a member database is maintained. Will interact daily with other departments regarding the members of their assigned state.

QUALIFICATIONS

• Computer skills required: Microsoft Office Suite, most notably Excel and Outlook
• Strong knowledge of Medicare Advantage enrollment life cycle.
• Ability to work well with others in a professional team-oriented environment.
• Excellent interpersonal and communication skills, and ability to converse comfortably with business leaders at all levels.
• Focus on details and accuracy a must.
• Prioritize activities in a multi-tasking environment.
• Experience with Medicare Advantage Plans (Preferred)

• Prepare and maintain enrollment and disenrollment requests.
• Reconcile, process, and maintain premium billing payments and balances.
• Ensures load and processing of monthly or daily enrollment transactions (i.e., TRRs)
• Research eligibility discrepancies and submit retroactive eligibility changes.
• Review monthly enrollment data validations (EDV’s)
• Submit and oversee Late Enrollment Penalty attestations and appeals.
• Process and investigate Good Cause requests.
• Work with Enrollment TPA to ensure compliance with all CMS regulations.
• Perform other duties as assigned.