Medicare Enrollment Specialist

WVU Medicine

About The Position

Welcome! We’re excited you’re considering an opportunity with us! To apply to this position and be considered, click the Apply button located above this message and complete the application in full. Below, you’ll find other important information about this position. Come join our Peak Health team at WVU Medicine as a Medicare Enrollment Specialist, contributing to the foundation for an innovative, new health plan. This position will report to the Enrollment Manager, playing a unique and important role in our mission to change healthcare for the better. Experience in Medicare and critical thinking skills will help the organization build an effective and efficient enrollment team. The enrollment team will review, execute, and oversee the processing of member enrollment application information for Peak Health’s Plan Suite. The Medicare Enrollment Specialist will analyze and process enrollment forms, checking for validity, completion, and accuracy. Ability to determine whether to enroll, outreach, or reject applications while following organizational policies and procedures is a must. This job reviews and evaluates all documents for quality control for final entry of member enrollment forms.

Requirements

High School diploma or equivalent
Two (2) year of experience working with medical or institutional data entry.
Two (2) year of customer service experience.
OR One (1) year of Medicare eligibility and Medicare Enrollment processing experience
Familiarity with Medical insurance enrollment processes.
Working Knowledge of administrative and clerical procedures and systems such as word processing and managing files and records.
Ability to take direction and to navigate through multiple systems simultaneously.
Excellent written and oral communication, customer service, interpersonal skills, and telephone etiquette skills.
Ability to solve problems with predefined methods and guidelines to drive improved efficiencies and customer satisfaction.
Requires exceptional attention to detail, the ability to be organized and to be able to perform multiple tasks simultaneously.

Nice To Haves

Associate Degree, or greater, in related healthcare field.
Three (3) to five (5) years of Medicare Enrollment processing and customer service experience.
Two (2) years of experience with Medicare elections, transaction codes, and reconciliation operations.
Two (2) years managing late enrollment penalty (LEP) for MAPD enrollees.
Familiarity with navigating CMS tools and resources, particularly the MARx website.
At least one (1) year of experience with system/user acceptance testing.
At least one (1) year of experience with developing and delivering trainings.

Responsibilities

Determine accuracy and completions of member form information. Entry/verifies form data.
Resolves enrollment issues to assure efficient and seamless member experience.
Maintains Medicare member enrollment records annually, indicating changes, updates, and outreach as required.
Meets all production and quality standards, maintaining Workqueues according to department standards.
Effectively communicates with internal and external staff.
Elevates issues to next level of supervision, as appropriate.
Ensures accuracy of data entered and record maintenance.
Attends all required training classes, demonstrating proficiency and ability to learn.
Manages coordination of benefits (COB) on member records.
Develops and Delivers department trainings to new hires.
Participates in system testing for any development rollouts.
Participates in department planning to ensure a successful Open Enrollment.
Other duties as deemed appropriate by the Management Team.
Processes SNP applications, verifying eligibility, including but not limited to Dual-Entitlement and residence within the service area.