Become a part of our caring community and help us put health first
 

The Enrollment Representative 4 processes applications from members, enrolls them on company platforms, and transmits enrollment to Center for Medicare and Medicaid Services. The Enrollment Representative 4 assumes ownership and leads advanced and highly specialized administrative/operational/customer support duties that require independent initiative and judgment.

Duties listed below vary in terms of importance and others may be added or eliminated as this position develops.  In addition, specific positions within the classification may have special duties and special qualifications.  Some of these duties and responsibilities may be assigned and performed to staff that this position will oversee.

• Process enrollments, disenrollment and various eligibility changes from the 834 files for Medicaid and Badger Care Plus.
• Enter Family Care Partnership (FCP) enrollments into the Enrollment ODS and interact with FCP staff members, the Wisconsin Department of Health Services (DHS), Centers for Medicare and Medicaid (CMS) and other external resources as needed.
• Enters Medicare enrollment form information into ACT and interact with the Sales Department on Medicare enrollment forms. Processes the Medicare enrollments timely and forwards the Medicare enrollments to Cognizant including the downloading and processing of the CMS TRR.
• Perform quality checks on various enrollment transactions completed monthly including weekly audits/verification of Medicare enrollments.
• Assist in the configuration and maintenance of Medicare Enrollment Model Letters to ensure compliant documentation is in use.
• Work with Finance in processing and reconciling member share and premium rate discrepancies for all lines of business and their encounter data. 
• Maintain iCare eligibility tables/data files and assure accuracy in enrollment reports as identified in enrollment processes. Alternate between Medicaid and Medicare enrollment functions and coordinate with various iCare departments accordingly. Identify, research and resolve eligibility inquiries and issues with CMS, Cognizant, iCare staff and other related parties. Assist in resolution of provider/enrollee complaints or appeals that relate to eligibility problems. Coordinate and perform COB validations including daily inquiries from various iCare departments, as well as monthly files received from DHS/CMS. Participate in internal and external audits by assisting in the preparation, providing documentation, and explaining the Enrollment Department’s processes to auditors as needed. Analyze trends within the enrollment department and take the necessary action to address them. Work collaboratively with the Customer Service and Enrollment Manager on department’s tasks and goals. Provide training to enrollment staff. Monitor the daily workflow of the department. Prepare documentation, workflows, procedures, etc. for all enrollment functions.

The Enrollment Representative 4 reviews reports and makes adjustments, additions, and deletions based on enrollment rules. Manages a daily inventory. Reports inventory daily. Decisions are regarding the daily priorities for an administrative work group and/or external vendors including coordinating work activities and monitoring progress towards schedules/goals, and often oversees work of others and/or is the primary administrative owner of a main process, program, product or technology. Works within broad guidelines with little oversight.

Use your skills to make an impact
 

Required Qualifications

• Three to five-year experience in the medical insurance, Medicaid and/or Medicare managed care insurance environment working with eligibility/enrollment information and resolution of enrollment issues.
• Two to 5 years of leadership/supervisory experience
• Two to 4 years of data analytical experience
• Have a detailed working knowledge of State Medicaid portal and/or Medicare CMS eligibility information systems and in depth understanding of Medicaid and Medicare eligibility terms and processes.
• Hands-on PC experience to include experience in data entry, word processing and spreadsheet applications.
• Demonstrated use of Microsoft Office applications including Excel, Word and Outlook.
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

• High School Diploma or GED
• Previous accounts receivable or billing experience and/or education

Additional Information

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