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Enrollment Eligibility Specialist

Company: Connected Care Resources Inc
Location: Newport Beach
Posted on: January 10, 2022

Job Description:

SummaryThe Enrollment Eligibility Specialist works collaboratively with the team to execute the day-to-day business processes required to support the delivery of critical health services: application intake, eligibility determination, enrollment processing to Center for Medicare and Medicaid Services, daily analysis of transaction reporting and validation of member materials. In this role you will demonstrate compliance with the Center for Medicare and Medicaid Services guidance. As Enrollment Specialist, you will collaborate with designated staff from internal Broker Support and Member Service, external vendors and other teams to develop and enhance solutions to improve the member's overall experience.Essential Duties and Responsibilities include the following. Other duties may be assigned.Process inbound Enrollment documentation: applications, creditable coverage attestation, disenrollment request, premium payments and other member documentation.Oversee entry of enrollment applications in the Health Plan enrollment system for new enrollees.Investigate and research potential invalid requests received by the plan to resolve errors.Process member updates in health plans enrollment system to ensure alignment with CMS records.Meet accuracy and timeliness requirements for processing enrollment transactionsCollaborate with team members to ensure membership records are reconciled and aligns with CMS's records.Use mail and documentation management systems and workflows for scanning and storing enrollment correspondence.Performs outreach to prospective enrollees as needed to confirm and clarify submitted information or incoming inquiries. Responding to member eligibility or group questions & verify enrollment status.Education and/or ExperienceHigh school diploma or general education degree (GED); or one to three months related experience and/or training; or equivalent combination of education and experience.At least 1-year of previous experience in Managed Care and Medicare preferred, but not required.Working Conditions and Additional RequirementsFast paced office and healthcare environment handling multiple demandsProfessional business environment within the CCRI officesBlend of internal and external (community, provider, regulatory) activityWhile performing the duties of this job, the employee is regularly required to sit, walk, and stand. The employee will be required to talk or hear on the phone and utilize a computerConfidential DataAll information (written, verbal, electronic, etc.) that an employee encounters while working at CCRI is considered confidential. Exposed to and required to deal with highly confidential and sensitive material and must adhere to corporate compliance policy, department guidelines/policies and all applicable laws and regulations at all times.Equal Opportunity EmployeeCCRI is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. PI160354860

Keywords: Connected Care Resources Inc, Newport Beach , Enrollment Eligibility Specialist, Other , Newport Beach, California

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