Ultimate Health Plans Hiring for Enrollment Specialist – Medicare Advantage Plan at Remote Full Time

You must live/reside in Florida. Candidates from other states will not be considered at this time.

The Enrollment Specialist is responsible for Enrollment of Medicare beneficiaries, prepares, processes and maintains new member applications, re-enrolls, dis-enrolls, LEP and plan changes or group enrollments and eligibility calculations 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.

• Data Enters applications, cancellations, and disenrollment’s
• Process, notifies and reports Medicare enrollment Manager Rejections, cancellations, and possible CMS rejections.
• Performs the daily and monthly TRR and coordinates with Analyst and Manager.
• Responsible for LEP processing, calculations and maintains hours and contributions in database on a monthly basis for eligibility calculations for reporting to insurance carriers for benefits.
• Responsible for reconciling, maintaining and tracking all new application in the receiving log and doing a reconciliation audit of all received applications versus applications in Log for processing. Send daily report to enrollment manager.
• Receives, stamps, and logs all correspondence received in the team in a timely and accurate manner according to CMS regulations and Ultimate Health Plans policy and procedures.
• Researches all Enrollment Elections Forms for completeness using all CMS regulations and time frames. Identifies and process all incomplete and complete enrollment elections in compliance with CMS regulations.
• Acts as liaison between enrollment and sales by filling the application issue log and reconciles documents and attachments in Enrollment log, against marketing submissions.
• Evaluate prospective members for Medicaid eligibility as needed. Monitor and process Medicaid recertification for current enrollees.
• Responds to member eligibility or group questions and verifies enrollment status. Answers telephones and transfers to appropriate staff member.
• Updates demographic data, benefits, and other fields in the Enrollment systems based on reports or other documents received and assigned by the Leadership direction.
• Process the Multi-County report and provide outcome to management
• Perform daily audits of scrubbing, data entry, and receiving processes.
• 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.
• Performs scanning and indexing in an accurate and timely manner of all forms in the Enrollment system. Performs indexing of enrollment applications timely and effectively by received date.

Desired Competencies

• Live/reside in Florida
• 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

Position Type and Expected Hours of Work

This is an non exempt time position. Typical days and hours of work are Monday through Friday, 8:00 a.m. to 5 p.m. with alternate schedules during Annual Open Enrollment period between October 15th and March 31 of each year.

Required Education and Experience

• High school diploma or equivalent plus two to three years’ previous experience highly desired.
• Must type at least 40 words per minute
• Previous experience in a Medicare and Medicaid Health Plan preferred
• Live in Florida –

Preferred Education and Experience

• Three to Five years of Medicare and Medicaid Enrollment Experience.

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Other duties may apply as assigned by Manager.

Job Type: Full-time

Pay: $19.00 – $22.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

Application Question(s):

• Are you a Florida Resident and live in Florida

Experience:

• Medicare and Medicaid Enrollment: 3 years (Required)
• knowledge of CMS standards, NCQA standards: 1 year (Required)

Work Location: Remote