Medicare Enrollment Specialist

About Wvumedicine

Welcome! We’re excited you’re considering an opportunity with us! To apply to this position and be considered, click the Apply button located above this message and complete the application in full. Below, you’ll find other important information about this position. 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. Experience in Medicare and critical thinking skills will help the organization build an effective and efficient enrollment team. The enrollment team will review, execute, and oversee the processing of member enrollment application information for Peak Health’s Plan Suite. The Medicare Enrollment Specialist will analyze and process enrollment forms, checking for validity, completion, and accuracy. Ability to determine whether to enroll, outreach, or reject applications while following organizational policies and procedures is a must. This job reviews and evaluates all documents for quality control for final entry of member enrollment forms.

Minimum Qualifications

Education, Certification, and/or Licensure:

• High School diploma or equivalent

Experience:

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

Preferred Qualifications

Education, Certification, and/or Licensure:

• Associate Degree, or greater, in related healthcare field.

Experience:

• 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.

Core Duties and Responsibilities

The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.

• Determine accuracy and completions of member form information. Entry/verifies form data.
• Resolves enrollment issues to assure efficient and seamless member experience.
• Maintains Medicare member enrollment records annually, indicating changes, updates, and outreach as required.
• Meets all production and quality standards, maintaining Workqueues according to department standards.
• Effectively communicates with internal and external staff.
• Elevates issues to next level.