Medicare Enrollment Specialist - Peak Health

About the role

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. The Medicare Enrollment Specialist will analyze and process enrollment forms, checking for validity, completion, and accuracy. The role reviews and evaluates all documents for quality control for final entry of member enrollment forms.

Responsibilities

• Determine accuracy and completion of member form information
• Entry/verify form data
• Resolve enrollment issues to assure efficient and seamless member experience
• Maintain Medicare member enrollment records annually, indicating changes, updates, and outreach as required
• Meet all production and quality standards, maintaining Workqueues according to department standards
• Effectively communicate with internal and external staff
• Elevate issues to next level of supervision, as appropriate
• Ensure accuracy of data entered and record maintenance
• Attend all required training classes, demonstrating proficiency and ability to learn
• Manage coordination of benefits (COB) on member records
• Develop and deliver department trainings to new hires
• Participate in system testing for any development rollouts
• Participate in department planning to ensure a successful Open Enrollment
• Process SNP applications, verifying eligibility, including but not limited to Dual-Entitlement and residence within the service area

Requirements

• High School diploma or equivalent
• Two (2) years of experience working with medical or institutional data entry
• Two (2) years of customer service experience
• OR One (1) year of Medicare eligibility and Medicare Enrollment processing experience

Qualifications

• 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

Skills

• 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
• Exceptional attention to detail, ability to be organized and to perform multiple tasks simultaneously

Physical Requirements

• Ability to sit for extended periods of time

Working Environment

• Standard office environment with electrical equipment (i.e., telephone, personal computer, copier, fax machines, etc.)
• Computer Software/Systems include but not limited to Microsoft Office Professional Suite (Outlook, Word, Excel, Access), Internet Explorer, and EPIC