HealthAxis Group is hiring an Enrollment Specialist to handle the enrollment of Medicare and Medicaid beneficiaries. In this role, you will process new enrollments and maintenance updates, making eligibility determinations while ensuring strict compliance with CMS regulations and company policies.
What You'll Do
- Make eligibility determinations based on CMS Part A/Part B guidelines.
- Accurately identify appropriate election periods by analyzing beneficiary history.
- Interact with internal and external customers to address and resolve inquiries.
- Achieve CMS requirements and Client Service Level Agreements.
- Adhere to and stay current with new regulations via training updates.
- Ensure the accurate, timely processing of enrollments and disenrollments.
- Process daily applications and disenrollments from various sources.
- Assist with daily reviews of the Daily Transaction Reply Report.
- Assist with tracking CMS OEC, Auto, and Facilitated web-based files.
- Research and respond to all internal and external customer inquiries.
- Generate correspondence and outreach for member requests.
- Perform root cause analysis for member inquiries or system errors.
- Accurately enter COB data for timely claims adjudication.
- Assist mailroom with processing Return Mail.
- Adhere to productivity, quality, and compliance expectations.
- Identify issue trends and opportunities for improvement.
- Drive the company culture through values and customer service standards.
- Be accountable for outstanding customer service.
- Develop and maintain positive relationships through effective communication.
- Take initiative to resolve and follow up on customer service issues.
What We're Looking For
- High school diploma or GED.
- Strong attention to detail.
- Customer service orientation.
- Ability to work effectively in a team and collaborate cross-functionally.
- Strong organizational, interpersonal, leadership, and communication skills.
- Excellent oral and written communication skills.
- Able to read and interpret documents.
- Proficient in MS Office with basic computer and keyboarding skills (40wpm).
- Excellent customer service skills (friendly, courteous, and helpful).
Nice to Have
- Minimum one-year of related experience.
- Knowledge of Medicare Advantage Guidelines per CMS Chapter 2.
- Knowledge of transactions between CMS and health plans.
Technical Stack
- MS Office
HealthAxis Group lives and works with purpose, cares about others, acts with integrity, communicates with transparency, and doesn’t take itself too seriously. Our commitment to a people-first approach shapes everything we do, from collaborating as a team to serving our valued clients.
