Phoenix American Medical, LLC Hiring for Enrollment Quality Specialist at Remote Full Time

Summary/Objective

The Enrollment Quality Specialist is responsible for Enrollment of Medicare beneficiaries as stipulated in the CMS guidelines including a variety of clerical duties involving typing, filing, records and reports maintenance; researching, documenting, evaluating, and executing all requested member enrollment transactions. Maintains strict member and company policy confidentiality.

Essential Functions

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as required for Mirra and/or Mirra clients, customers, and affiliates.

• Audit and researches all Enrollment Elections Forms for completeness using all CMS regulations and time frames. Identifies all incomplete and complete enrollment elections in compliance with CMS regulations.
• Audits, according to CMS regulations, all Completed Elections from existing members and processes them within CMS time frames.
• Audit and reconciles documents and attachments in Enrollment log, against marketing submissions.
• Daily Audit of letters, batching and approving to print the notices.
• Prepares written responses using Federal Regulations guidelines and time frames.
• Performs audits of all prospective members for HMO, SNP, Medicaid eligibility as needed. Audit, monitor and process Medicaid recertification for current enrollees.
• Audit hours and contributions in database on a monthly basis for eligibility calculations for reporting to insurance carriers for benefits.
• Responds to member eligibility or group questions and verifies enrollment status. Answers telephones and transfers to appropriate staff member.
• Perform daily audits of applications/disenrollment, scrubbing procedures, data entry accuracy, internal departments processes, and government agencies processes.
• Audits daily TRR, CMS rejections, LEP, Premium Billing and Payment, EDV retro transactions, etc.
• Provides coaching to team members based on audit results and maintains monthly meeting updates with management on employee improvements.
• Update’s demographic data, benefits and other fields in the Enrollment systems based on reports or other documents received and assigned by the Leadership direction.
• Process report to compare Enrollment system data against Claims system data
• Audit the county mismatches report and provide outcome to management.
• Works monthly reconciliation reports assigned by Leadership directions.
• Operates computers programmed with Enrollment software to record, store and analyze information.
• Plans and carries out recurring work using established procedures, conferring with the supervisor or higher-level specialists as necessary on technical problems.
• Review’s member document, verifies information and prepare audit forms for data entry oversight for outsourcing team, audit the work by outsource team and provide feedback to send clean enrollment transaction to CMS.
• Performs scanning and indexing in an accurate and timely manner of all forms in Enrollment system. Performs indexing of enrollment applications timely and effectively by signature date.
• Audits receives, stamps, and logs all correspondence received in the team in a timely and accurate manner according to CMS regulations and Mirra’s policy and procedures.

Desired Competencies

• MS Office experience
• Medicare/ Medicaid Member Enrollment experience
• ADOBE and Microsoft proficiency with strong practical Excel experience
• CMS regulation knowledge
• Customer Service experience
• Ethical Conduct
• Thoroughness, attention to detail

Supervisory Responsibility

This position has no supervisory responsibilities.

Work Environment

This job operates in a clerical, office setting. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.

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.

This is a largely sedentary role; however, some filing is required. This would require the ability to lift files, open filing cabinets and bend or stand on a stool as necessary.

Position Type and Expected Hours of Work

This position will work 8 a.m. to 5 p.m., Monday-Friday, and during Annual Open Enrollment will work 8 a.m.-8 p.m. Monday-Friday and Saturdays.

Travel

No travel is expected for this position.

Required Education and Experience

• High school diploma or equivalent plus one to three years’ previous experience highly desired.
• Must type at least 40 words per minute
• Previous experience in Managed Care and Medicare preferred

Preferred Education and Experience
Two to three years Medicare Enrollment Experience.

Job Type: Full-time

Pay: $23.00 – $25.00 per hour

Schedule:

Work Location: Remote