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Under the direction of department Leadership, the Enrollment Specialist will be responsible for successfully verifying eligibility and complete all enrollment transactions for all segments of the business
The position responsibilities include:
* Strict adherence to all Federal and State regulations and our State of Nevada department of insurance guidelines.
* Strict adherence to eligibility and enrollment criteria governed by the Centers for Medicare & Medicaid Services (CMS) Medicare Managed Care Manual. Responsible for updating and creating Policy and Procedures for Enrollment.
* Entering enrollment transactions timely and accurately per the enrollment procedures.
* Ensuring reconciliation of all enrollment transactions to the enrollment forms to verify appropriate family coverage and tier match Hometown Health system.
* Working closely with our group administrators/contacts and members to ensure that enrollment is processed timely and accurately to avoid delay of enrollment, termination or disruption of their benefit plan when information received is not complete.
* Managing workloads independently as well as part of a team.
* Responsible for auditing and testing membership system upgrades.
* Front line audit support with Auditors (internal & external) for annual filings.
* Participates with Configuration Analyst to create processes to maximize accuracy and quality measures required by departmental success.
* Trains and mentors new Enrollment Representatives.
* Periodically assist Enrollment Analyst in auditing Enrollment Representative work to verify enrollment entered is in compliance with the group's Eligibility Provision, the commercial Evidence of Coverage, the Group Subscription Agreement and the Summary Plan Documents for self funded clients.
* Works on multiple complex transactions with high quality results and adherence to deadlines.
* Manages Employer group and member relationships ensuring enrollment is processed timely and accurately to avoid delay of enrollment, termination or disruption of their benefit plan when information received is not complete.
* Maintain regular communication with Leadership, Configuration Analysts and customers.
* Verifying eligibility in multiple databases, including but not limited to the Medicare Advantage Prescription Drug (MARx) system, Group Eligibility Provision, Evidence of Coverage Document, Group Subscription Agreement, Group Self Funded Summary Plan Document, Departmental policies & procedures, Provider Directory before coding and entering membership into the Hometown Health's managed care information system.
* Performing critical thinking and analysis in determining the appropriate group, benefit package and riders to assign to members.
* Performs special projects including but not limited to system implementations as assigned by Leadership.
* Works directly with the Information Technology team in reporting and testing electronic file issues.
* Cross Trains in Revenue Department.
* Performing other revenue-related duties as assigned.
This position does not provide patient care.
Incumbent is expected to type a minimum of 45+ WPM adjusted for error. Must have strong computer skills, including but not limited to, expert level understanding of Microsoft Office Suite, including Outlook, intermediate skills in Excel spreadsheets and formulas in addition to possessing basic Word skills.
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