Summary

The Enrollment Specialist is responsible for all new plan enrollments as well as verifying and tracking Special Needs Plan (CSNP) enrollments. Researching errors by comparing enrollment error reports against system information along with CMS (Center for Medicare and Medicaid Services) records.  Ensures the daily workflow of enrollment is monitored and accurate information is disseminated.

Essential Duties and Responsibilities

Essential duties and responsibilities include but are not limited to:

1. Sending correspondence to Members or CMS (Center for Medicare and Medicaid Services) to gather information or provide updates for corrections. 
2. Ensure that all enrollments, denials and rejects meet Medicare guidelines (Chapter 2 Medicare Advantage Enrollment and Disenrollment manual).
3. Responsible and accountable for the training, and overall performance of the Enrollment t staff to ensure that all qualitative and quantitative goals and objectives are met within the department.
4. Responsible for ensuring regulatory compliance in all areas that affect the Enrollment Unit.
5. Create, develop and implement programs that may benefit the unit.
6. Ensure daily TRR is validated and all transactions are reviewed.
7. Act as a liaison to the Sales Representatives.  Ensure that new enrollments are processed properly.  Provide any issues identified to the necessary internal department heads.
8. Data entry of all enrollment applications as well as disenrollments into plan’s data system.
9. Verify eligibility for CSNP enrollments as well as ensure that all qualifying documentation is included with enrollment application.
10. Contact Physician/Specialist offices to obtain qualifying documentation as needed.
11. Track all pending enrollments for additional information needed for qualification.
12. Assist in the departmental compliance tasks which include the Mailing, Annual Notice of Change Letter, and all other necessary compliance mailings.
13. Responsibilities include training of employees; planning, assigning and directing work; assisting in the rewarding and disciplining of assigned employees; addressing complaints and resolving problems as they pertain to respective units
14. Submit monthly reports to the Membership Manager of, enrollment applications processed and returned and number of mailed packets and returned mail.

Qualifications

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.

1. Education and/or Experience:  High school diploma or general education degree (GED) preferred but not required; or one to three months related experience and/or training; or equivalent combination of education and experience.
2. Certificates, Licenses, Registrations:  None required.
3. Other Qualifications: 
1. Knowledge of Medicare Managed Care Plans.
2. Two to three years customer service experience.
3. Direct sales or related experience preferably in the Managed Care industry.
4. Bi-lingual (English/Spanish) required.
5. Must have two years’ experience in the health care field.
6. Must be familiar with CMS MMR and TRR files

 Skills and Abilities 

1. 1. Language Skills:  Ability to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals.  Ability to write routine reports and correspondence.  Ability to speak effectively before groups of customers or employees of the organization.
   2. Mathematical Skills:  Ability to add and subtract two digit numbers and to multiply and divide with 10’s and 100’s.  Ability to perform these operations using units of American money and weight measurement, volume, and distance.
   3. Reasoning Skills:  Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions.  Ability to deal with problems involving a few concrete variables in standardized situations.
   4. Computer Skills:  Strong computer skills.
   5. Other Skills and Abilities: