Medicare Enrollment Specialist

Medicare Enrollment Specialist

Location: Birmingham, AL

Work Schedule: Hybrid with regular work performed at our downtown Birmingham office and some remote work opportunities.

Why VIVA HEALTH?

VIVA HEALTH, part of the renowned University of Alabama at Birmingham (UAB) Health System, is a health maintenance organization providing quality, accessible health care. Our employees are a part of the communities they serve and proudly partner with members on their healthcare journeys.

VIVA HEALTH has been recognized by Centers for Medicare & Medicaid Services (CMS) as a high-performing health plan and has been repeatedly ranked as one of the nation's Best Places to Work by Modern Healthcare.

Benefits

• Comprehensive Health, Vision, and Dental Coverage
• 401(k) Savings Plan with company match and immediate vesting
• Paid Time Off (PTO)
• 9 Paid Holidays annually plus a Floating Holiday to use as you choose
• Tuition Assistance
• Flexible Spending Accounts
• Healthcare Reimbursement Account
• Paid Parental Leave
• Community Service Time Off
• Life Insurance and Disability Coverage
• Employee Wellness Program
• Training and Development Programs to develop new skills and reach career goals
• Employee Assistance Program

See more about the benefits of working at Viva Health - https://www.vivahealth.com/careers/benefits

Job Description

The Medicare Enrollment Specialist is responsible for processing all Medicare enrollments, disenrollments, plan changes, cancellations, premium payment transactions, and late enrollment penalty transactions within Centers for Medicare and Medicaid (CMS) timeframes. The position is also responsible for all member maintenance such as Low Income Subsidy updates, Medicaid updates, Long Term Care verification, various departmental reports for reconciliation of systems, and Out of Service Area research including address verification in plan systems and returned mail on Medicare members.

Key Responsibilities

• Maintain knowledge of all CMS guidelines regarding Medicare Advantage Enrollment and Disenrollment, Medicare Prescription Drug Benefit, Creditable Coverage Period Determinations, and Late Enrollment Penalty.
• Screen all enrollment applications and plan changes to ensure all CMS required elements are complete including eligibility for plan and election selected based on CMS systems, State Medicaid system, and information provided by beneficiary.
• Request additional information from the prospective member or current member via telephone contact and/or correspondence.
• Perform data entry and/or data validation of all enrollments, disenrollments, cancellations, and plan changes in the enrollment system and/or PowerSTEPP.
• Perform maintenance actions to member records for Low Income Subsidy updates in the enrollment system and PowerSTEPP including sending appropriate rider to member.
• Identify members with a gap in Part D coverage and provide them with creditable coverage attestation forms. Track forms and process transactions for completed forms.
• Responsible for processing transactions and notices for the chosen billing method according to department guidelines and CMS regulations.
• Reconcile plan systems with daily, weekly, monthly, or quarterly CMS reports according to departmental guidelines.
• Research all members who are potentially out of the service area including contact with member, generating required notices, and follow-up and disenrollment transactions to CMS.

REQUIRED QUALIFICATIONS:

• High School Diploma or GED
• 1 year experience in managed care or health insurance
• Ability to work under pressure to meet deadlines with little to no supervision
• Ability to work in a team environment, remaining flexible to ideas, recognizing responsibilities, and actively participating with others to accomplish assignments and achieve desired goals
• Demonstrate excellent customer service skills through written and verbal communication
• Proficient in Microsoft Word and Excel

PREFERRED QUALIFICATIONS:

• Associate's Degree
• Medicare managed care enrollment experience
• AS400/POWERSTEPP/TXEN or similar mainframe experience
• Cognizant Elements Enrollment Application Manager software experience
• Microsoft Access experience