Enrollment Coordinator

Mô tả công việc

Health Choice exists to improve the health and well-being of the individuals we serve through our health plans, integrated delivery systems and managed care solutions. We strive to recruit and retain only the finest health care professionals with the highest levels of integrity, compassion and competency. If you are driven by your own personal commitment to these values and desire to work in a team-focused, collaborative and supportive environment – while still being valued for your individual strengths – Health Choice is the place for you. Equal Opportunity Employer Minorities/Women/Veterans/Disabled The Medicare Enrollment Coordinator processes enrollment applications with quality and efficiency and assists in all aspects of the enrollment/disenrollment process by following reporting requirements and ensuring all transactions are in accordance with Centers for Medicare and Medicaid Services (CMS) regulations. Process new member enrollments including verification of eligibility for Medicare and AHCCCS: • Meet CMS reporting requirements and standards • Complete reviews of the necessary reporting to and receiving information from CMS regarding enrollment and disenrollment • Maintain files of every enrollment application received by Health Choice Generations along with copies of enrollment/disenrollment communications • Submit eligibility applications and disenrollments to CMS • Retrieve reports/files from CMS • Reconcile data received from CMS • Implement process updates/changes appropriately • Create and mail letters to members • Review out of service area members to determine when involuntary disenrollment process should begin • Complete telephone enrollment verification with member to clarify member’s understanding of Health Choice Generations Plan and benefits Identify and resolve enrollment issues: • Collaborate with Finance and Compliance Departments, internal brokers to resolve enrollment, disenrollment and payment issues • Identify problems and issues within the system that could cause enrollment/disenrollment data not to be reported • Offer input for areas of improvement • Submit data to retro-processing center Assist internal brokers in enrollment process • Verify eligibility • Identify and communicate potential enrollment issues to the Medicare Compliance Officer Identify enrollment/disenrollment trends • Prepare enrollment reports for management • Provide information on enrollments and members’ eligibility changes to Retention staff