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Enrollment Specialist
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Reference Number:
IK-Enrollment


Job Description:
Applicant must have healthcare enrollment experience and experience with Medicaid.

Data enter the application(s) using the correct election into the database within 7 calendar days of the plan?s receipt.
Ensures timely submission of enrollments to Centers for Medicare & Medicaid Services (CMS).
Generates and sends required member correspondence during processing of enrollment and disenrollment requests.
Updates member records with changes relating to their enrollment which may include: Low Income Subsidy (LIS) updates, Medicaid updates, demographic updates, and effective/disenrollment changes.
Maintains a working knowledge of CMS regulations as they relate to the members enrollment in the plan.
Guarantees all required membership materials are sent within the required timeframes.
Analyzes and summarize monthly reports to identify current trends of enrollments and dis-enrollments and develop strategies to address trends and ensure the continued growth of the program.
Develops a working knowledge and understanding of out of area tracking, all low income subsidy processes, late enrollment penalty appeals and retroactive processing procedures.

OTHER RESPONSIBILITIES

Include other significant responsibilities needed to accomplish job purpose/goals that are performed on a daily or infrequent basis.

Creates a new member file to hold application and all documents concerning the member?s enrollment.
Date stamps all withdrawal, cancellation, and disenrollment requests.
Determines whether or not a member is eligible to cancel or disenroll from the plan.
Enters the disenrollment in the database and ensure timely submission of the cancelation and disenrollment requests to CMS.
Ensures all appropriate documentation is accurately maintained in the member file.
Facilitates obtaining any information that?s missing or needed for the members file.
Researches, troubleshoots, and reconciles CMS file errors to ensure member?s file reflects accurate and up to date information.
Assists with the monthly capitation and reconciliation.
Researches LIS and LEP discrepancies and update database with correct information when necessary.
Works with the Finance Department to reconcile/resolve member reimbursement issues.
Extensive knowledge of Medicare, Medicare Enrollment Periods, CMS Plan Communications Guide, Best Available Evidence, Credible Coverage, and New York State Medicaid is preferred.
Coordinate input from various Subject Matter Experts (SMEs) that support the enrollment, reconciliation and billing functions.
Date stamps all pages of the enrollment application and any additional documentation submitted.
Reviews enrollment applications for completeness and performs an initial review of eligibility.
Perform other duties as assigned.

MINIMUM JOB REQUIREMENTS


High school degree or equivalent required, college degree work preferred or, an equivalent combination of education and related work experience required.
Display courtesy, tact, and patience during interactions with members, employees and extended community.
Demonstrate knowledge and/or experience with Medicaid/Medicare rules and regulations.
Experience with CMS and HRA Operating Systems.
Demonstrate excellent verbal and written communication skills.
Exhibit ability to read and communicate effectively in English.
Exhibit basic computer knowledge including Microsoft (Word, Excel, Access and Outlook).
Demonstrate ability to work effectively in a team environment.
Demonstrate ability to communicate effectively in front of small groups and in one-on-one discussions.
Demonstrate understanding and sensitivity to multi-cultural values, beliefs, and attitudes of both internal and external contacts.
Demonstrate appropriate behaviors in accordance with the organization?s vision, mission, and values.

Please email resumes to ikramer@winstonstaffing.com or fax to 646-459-2177


Experience Level:
Unspecified


Requirements:
Applicant must have healthcare enrollment experience and experience with Medicaid.

Data enter the application(s) using the correct election into the database within 7 calendar days of the plan?s receipt.
Ensures timely submission of enrollments to Centers for Medicare & Medicaid Services (CMS).
Generates and sends required member correspondence during processing of enrollment and disenrollment requests.
Updates member records with changes relating to their enrollment which may include: Low Income Subsidy (LIS) updates, Medicaid updates, demographic updates, and effective/disenrollment changes.
Maintains a working knowledge of CMS regulations as they relate to the members enrollment in the plan.
Guarantees all required membership materials are sent within the required timeframes.
Analyzes and summarize monthly reports to identify current trends of enrollments and dis-enrollments and develop strategies to address trends and ensure the continued growth of the program.
Develops a working knowledge and understanding of out of area tracking, all low income subsidy processes, late enrollment penalty appeals and retroactive processing procedures.

OTHER RESPONSIBILITIES

Include other significant responsibilities needed to accomplish job purpose/goals that are performed on a daily or infrequent basis.

Creates a new member file to hold application and all documents concerning the member?s enrollment.
Date stamps all withdrawal, cancellation, and disenrollment requests.
Determines whether or not a member is eligible to cancel or disenroll from the plan.
Enters the disenrollment in the database and ensure timely submission of the cancelation and disenrollment requests to CMS.
Ensures all appropriate documentation is accurately maintained in the member file.
Facilitates obtaining any information that?s missing or needed for the members file.
Researches, troubleshoots, and reconciles CMS file errors to ensure member?s file reflects accurate and up to date information.
Assists with the monthly capitation and reconciliation.
Researches LIS and LEP discrepancies and update database with correct information when necessary.
Works with the Finance Department to reconcile/resolve member reimbursement issues.
Extensive knowledge of Medicare, Medicare Enrollment Periods, CMS Plan Communications Guide, Best Available Evidence, Credible Coverage, and New York State Medicaid is preferred.
Coordinate input from various Subject Matter Experts (SMEs) that support the enrollment, reconciliation and billing functions.
Date stamps all pages of the enrollment application and any additional documentation submitted.
Reviews enrollment applications for completeness and performs an initial review of eligibility.
Perform other duties as assigned.

MINIMUM JOB REQUIREMENTS



High school degree or equivalent required, college degree work preferred or, an equivalent combination of education and related work experience required.
Display courtesy, tact, and patience during interactions with members, employees and extended community.
Demonstrate knowledge and/or experience with Medicaid/Medicare rules and regulations.
Experience with CMS and HRA Operating Systems.
Demonstrate excellent verbal and written communication skills.
Exhibit ability to read and communicate effectively in English.
Exhibit basic computer knowledge including Microsoft (Word, Excel, Access and Outlook).
Demonstrate ability to work effectively in a team environment.
Demonstrate ability to communicate effectively in front of small groups and in one-on-one discussions.
Demonstrate understanding and sensitivity to multi-cultural values, beliefs, and attitudes of both internal and external contacts.
Demonstrate appropriate behaviors in accordance with the organization?s vision, mission, and values.

Please email resumes to ikramer@winstonstaffing.com or fax to 646-459-2177


Location:
New York NY


Duration:
Contract to Direct


Pay Rate:
$15-$40/hr.


Date Posted: 07/11/2016
Last Updated: 07/11/2016