Medicare Enrollment Senior Analyst

Central Coast Salary Range - $84,877 - $123,072

While candidates from anywhere in California are welcome to apply, there is a strong preference for those who reside on the Central Coast (Ventura, Santa Barbara, San Luis Obispo, Monterey and Santa Cruz Counties). This role may offer opportunities for remote work; however, familiarity with and proximity to our local customers is valued.

Job Summary
 

The Medicare Enrollment Senior Analyst at CenCal Health holds a critical role within the Customer Experience Division, reporting to and assisting the Medicare Enrollment Manager. They will ensure oversight of accurate processing of transactions, and act as a Subject Matter Expert in Enrollment and Dis-Enrollment Processes.

Duties and Responsibilities

• This position has duties included but not limited to:
   

  • Oversight of our vendor and the Centers for Medicare & Medicaid Services (CMS) and the Department of Health Care Services (DHCS).
     

  • Overseeing and managing all enrollment-related transactions.
     

• The Medicare Enrollment Senior Analyst ensures oversight of accurate processing of transaction duties included but not limited to:
   

  • Timely processing and data entry of Medicare enrollments, re-enrollments and dis-enrollments.
     

  • Performing subsequent maintenance of enrollment and eligibility data.
     

  • Ensuring compliance with regulatory requirements. 
     

  • Assisting the Medicare Enrollment Manager in filing applications and other related materials to facilitate and enhance CenCal Health’s operational and financial goals for a high-quality and fully compliant D-SNP product line.
     

• Act as a Subject Matter Expert in Enrollment and Dis-Enrollment Processes with duties included but not limited to:
   

  • Auditing and Reviewing Transactions ready to be sent to CMS.
     

  • Auditing letters daily.
     

  • Collaborating with cross-functional teams including IT, Compliance, Finance, Marketing, Sales, and other operational departments to identify and streamline enrollment workflows and resolve complex issues.
     

  • Assisting in the development of Standard Operating Procedures.
     

Knowledge / Skills/  Abilities

• Minimum 5 years of Medicare enrollment and premium billing experience in Operations is preferred. Strong background with CMS eligibility protocols and transactions, as it relates to Medicare Advantage Prescription Drug (MAPD) plan enrollment processing.
   

• Sound working knowledge of CMS guidance in relationship to duties and responsibilities related to MAPD membership management.
   

• Experience with the MARx application, CMS TRR, TRC and TC systems notification impacting eligibility.
   

• Ability to organize team members and prioritize across multiple complex projects.
   

• Proven written and oral communication skills.
   

• Excellent verbal, analytical, organizational, and written skills.
   

• Advanced proficiency in Microsoft Office, including Excel.
   

• Experiencing processing CMS Transaction Files and Medi-Cal 834 eligibility.
   

• Proven tr