77 applicants

Company

Blue Cross and Blue Shield of Nebraska · 1 day ago

Medicare Advantage Enrollment Specialist II

Remote Kansas

Full-time

Remote

Mid Level

3+ years exp

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Comp. & Benefits

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Responsibilities

Develop knowledge of CMS Manual Chapter 2 and Part D Manual Chapter 3, Eligibility, Enrollment and Disenrollment, terminology, and concepts of election periods, enrollment, and disenrollment.

Ensure the accuracy and timeliness of processing enrollments and disenrollment in compliance within CMS regulations and BCBSNE policies and procedures.

TRR Processing knowledge.

Research and resolve enrollment audit findings and identify potential gaps, make recommendations to implement process improvements.

Provide peer skills enhancement training to address any gaps in process and/or technology.

Assure billing processes, delinquency, refunds, and other financial updates are completed to member profiles to accurately reflect expected results.

Responsible for determining accurate results for transaction reply codes based on CMS guidance; accountable for resolving and closing pended enrollment records in the core administrative system.

Adhere to productivity, quality, and compliance expectations.

Research, resolve and submit CMS required enrollment audits and case reviews.

Collaborate with other team members on special projects as assigned by the Manager, including process documentation, training, and quality audits.

Conduct maintenance and resolution for daily systems reconciliation and discrepancy reports.

Qualification

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Medicare Enrollment ProcessingCMS Regulations KnowledgeExcelMicrosoft Word

Required

Associate's degree in a related field or equivalent experience.

3 years of professional experience in processing Medicare Enrollment transactions.

Minimum 1 year experience in the health care industry.

Excellent verbal and written communication skills.

A strong work ethic with the ability to multi-task is essential.

Ability to work independently, prioritize and work under deadlines. Attention to detail.

Knowledge and experience using Excel, Microsoft Word, and ten-key efficiency; ability to quickly adapt to new systems.

The ability to adapt quickly to a fast-paced environment, self-starter, and quick learner.

Interpersonal skills to work well within a team that includes all levels within the organization from clerical and support staff to senior management as well as members and brokers outside of the organization.

Ability to analyze enrollment reconciliation data, complex case files, and audit findings for resolution.

Report SLAs, KPIs, and other operations reports and present findings in a structured format.

The ability to meet or exceed the attendance and timeliness requirements of their departments.

The ability to work well in a team environment and be capable of building and maintaining positive relationships with other staff, departments, and customers.