The Team Lead, Enrollment is responsible for performing duties related to enrollment of Medicare beneficiaries (in Medicare Advantage Plans) and Medicaid beneficiaries. Applies comprehensive knowledge of CMS guidelines. Ensures daily and weekly automated processes are completed timely and accurately. Demonstrates a sense of urgency, able to meet deadlines and lead team by example.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
Daily/ weekly and monthly reconciliation of membership against plan record and CMS
QA of daily submission files to CMS/Audit
Monitor various work flow processes
Act as Subject Matter Expert for area of responsibility
Research and resolve issues per member correspondence
Maintain various production logs
Work various reports
Conduct new associate training in area of policies/procedures and workflow processes
Develop job aids and policies/ procedures.
Ability to handle multiple tasks and complete work under tight deadlines
QUALIFICATIONS AND REQUIREMENTS : To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
EDUCATION and/or EXPERIENCE: High school diploma or general education degree (GED) required; minimum two years related experience preferred; or an equivalent combination of education, training and experience.
NECESSARY KNOWLEDGE, SKILLS AND ABILITIES: Knowledge of Medicare Advantage Guidelines per CMS Chapter 2, and knowledge of transactions between CMS and health plan. Ability to read and interpret documents, excellent communication skills, good grammar, voice and diction, proficient in MS Office, basic computer and keyboarding skills (40wpm), detail oriented and highly organized, excellent customer service skills (friendly, courteous and helpful).
LICENSING AND CERTIFICATION: None required for this position.
PHYSICAL DEMANDS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to sit. The employee frequently is required to use hands 10 finger, handle, or feel objects, tools, or controls and talk or hear.
Specific vision abilities required to this job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.
WORK ENVIRONMENT : The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
The noise level in the work environment is usually moderate.
For the most part ambient room temperatures, lighting and traditional office equipment as found in a typical office environment.
ADDITIONAL INFORMATION: The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.
The duties listed above are intended only as illustrations of the various types of work that may be performed. The omission of specific statements of duties does not exclude them from the position if the work is similar, related or a logical assignment to the position.
We are proud to be an EEO/AA employer M/F/D/V. We maintain a drug-free workplace and perform pre-employment substance abuse testing.
Freedom Health - 2 years ago
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