Enrollment Analyst

About the Organization

Prominence Health is a value-based care organization bridging the gap between affiliated health systems and independent providers, building trust and collaboration between the two. Founded in 1993 as a health maintenance organization (HMO), Prominence Health was acquired by a subsidiary of Universal Health Services, Inc. (UHS) in 2014. The organization serves members, physicians, and health systems across Medicare, Medicare Advantage, Accountable Care Organizations, and commercial payer partnerships. Prominence Health is committed to transforming healthcare delivery by improving health outcomes while controlling costs and enhancing the patient experience.

Responsibilities

• Handle all aspects of enrollment for all lines of business, including preparing enrollment applications, disenrollments, cancellations, and eligibility changes for processing.
• Download documents from HPMS and manage enrollment queues.
• Review, research, route, and readdress return mail.
• Work with Customer Service to obtain updated mailing information for members.
• Process PCP changes, demographic changes, and HIPAA release requests.
• Review and research Medicare entitlement; provide support by creating manual letters when needed.
• Collaborate with IT staff, outside system programmers, and new and existing clients to ensure all components of electronic enrollment are programmed appropriately for customer satisfaction.
• Perform any other delegated responsibilities.

Requirements

• High school diploma or equivalent; Associate’s degree preferred.
• 1 to 3 years of experience.
• Basic knowledge of Medicare regulations and experience in Managed Care Enrollment (MA, MAPD, and PDP).
• Previous experience processing Medicare Advantage enrollment applications and generating letters.
• Experience reviewing and analyzing statistical data to identify trends and potential problems or opportunities for improved service quality.
• Experience working with CMS-contracted vendors and systems (e.g., Retroactive Processing Contractor (RPC), Wipro, MARx) is preferred.
• Experience in computer operations, including troubleshooting and preferably electronic data interchange.

Skills

• Ability to analyze statistical data and recognize problems or potential problems, taking appropriate steps to resolve them.
• Self-starter with the ability to recognize priorities and manage workload accordingly.

Benefits

• Loan Forgiveness Program
• Challenging and rewarding work environment
• Competitive compensation and generous paid time off
• Excellent medical, dental, vision, and prescription drug plans
• 401(K) with company match and discounted stock plan
• SoFi Student Loan Refinancing Program
• Career development opportunities within UHS and its 300+ subsidiaries

More information is available on the Benefits Guest Website.