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Medicare Marketing Specialist
Medicare Enrollment Specialist
Greensboro, NC • Member Services
In conjunction with the Director of Operations- Member Services, Enrollment, the Enrollment Specialist is responsible for maintaining accurate membership information within the Membership Enrollment portal and for ensuring that enrollment activities are conducted in compliance with CMS requirements. They are also responsible for generating weekly and monthly membership data reports are completed according to establish deadlines and guidelines. Staffing metric is optimal at 1:10,000 membership volume to ensure all enrollment functions and auditing of transactions are accurate and resolved correctly.
Major Work Activities
Accomplishes daily enrollment/ dis-enrollment operations, including application review through the TPA system.
Assists TPA in obtaining missing information for enrollment completion, coordinating with Sales & Marketing for agent outreach.
Initiates corrections to CMS or RPC in conjunction with TPA.
Reviews monthly CMS reports including MMR, TRR, Plan Payment Report, and Demographic Report. Compares reports to eligibility file and resolves any discrepancies with member status data in conjunction with Finance.
Coordinates with Sales & Marketing department on the application process.
Reconciles membership with TPA and OEC.
Performs eligibility checks as needed and upon request.
Prepares both internal and external enrollment report, including monthly and annual CMS reporting.
Accountable for CMS monitoring visits, including visit preparation, mock visits, and actual visits, responses on issues with respect to enrollment; ensures recommended changes are implemented.
Coordinates with TPA to ensure new processes for newly effective CMS requirements or changes to existing enrollment policies are documented and implemented
Coordinates the collection, reporting, and analysis of plan data per CMS guidance.
Other duties as assigned
Bachelor’s Degree in business, or other healthcare-related field or three (3) or more years equivalent work experience
Three (3) or more years experience in the health care industry.
Three (3) years’ experience with customer service or transaction processing in a Managed Care setting required.
Medicare Advantage/Medicare Advantage Part D plan knowledge and enrollment activities preferred.
Strong in Word, Excel, Access, and PowerPoint
Knowledge, Skills, and Abilities
Understanding of Medicare Advantage and Part D Programs
Knowledge of Medicare Advantage Guidelines per CMS Chapter 2, and knowledge of transactions between CMS and health plans
Strong in the following competencies:
Self-motivated with excellent follow-through
Ability to work independently and with a team
Experience working with regulatory agencies.
Preferred Knowledge, Skills, and Abilities
Knowledge of provider practice operations
Time: Full time
Updated: 3/31/2021 1:53:59 PM