Enrollment Specialist

Company Overview

HealthAxis is a prominent provider of core administrative processing system (CAPS) technology, business process as a service (BPaaS), and business process outsourcing (BPO) capabilities to healthcare payers, risk-bearing providers, and third-party administrators. We are transforming the way healthcare is administered by providing innovative technology and services that uniquely solve critical healthcare payer challenges negatively impacting member and provider experiences.

We live and work with purpose, care about others, act with integrity, communicate with transparency, and don’t take ourselves too seriously.

We're not just about business – we're about people. Our commitment to a people-first approach shapes everything we do, from collaborating as a team to serving our valued clients. We believe that creating a vibrant and human-centric environment can inspire engagement, empower our team members, and ignite a sense of purpose in all that we accomplish.

Purpose And Scope

The Enrollment Specialist is responsible for performing duties related to enrollment of Medicare and Medicaid beneficiaries. Responsible for processing new and or maintenance updates to enrollment eligibility in the membership systems. Demonstrates the skills and ability to analyze information to make appropriate decisions regarding eligibility in compliance with regulations and governance set forth by the Centers for Medicare and Medicaid Services (CMS) and HealthAxis. The Enrollment Specialist is required to make eligibility determinations based on CMS (Part A/Part B Eligibility) in accordance with the application election period guidelines. To accurately identify appropriate election period based upon analysis of beneficiary/member history and regulatory guidance. Interacts with both internal and external customers to address and resolve inquiries or complaints and achieve CMS requirements and Client’s Service Level Agreements (SLAs). Must adhere to and keep up to date with new regulations and guidance provided during training updates.

Principal Responsibilities And Duties

• Ensure the accuracy and timeliness of processing enrollments and disenrollment in compliance within Medicare and Medicaid regulations and HealthAxis’ policies and procedures.
• Process daily applications and disenrollment received via the various sources in the membership systems for daily transmission to CMS.
• Assist with daily reviews and processing of the Daily Transaction Reply Report (DTRR).
• Assist with tracking and oversight of CMS OEC, Auto and Facilitated web-based files.
• Research and responds to all internal and external customer inquiries.
• Generate appropriate correspondence to outreach to members request, as necessary.
• Performs root cause analysis to determine issues related to member inquiry and or system errors.
• Attention to detail is critical to the success of this position, with skills in customer orientation.
• Accurately enter COB for timely and accurate claims adjudication
• Assist mailroom with processing Return Mail.
• Adhere to productivity, quality, and compliance expectations.
• Identifies issue trends and opportunities for improvement.
• Be a supportive and collaborative team member.
  
  

Customer Service

• Responsible for driving the HealthAxis culture through values and customer service standards.
• Accountable for outstanding customer service to all external and internal contacts.
• Develops and maintains positive relationships through effective and timely communication.
• Takes initiative and action to respond, resolve and follow up regarding customer service issues with all customers in a timely manner.
  
  

Education, Experience And Required Skills

• High school diploma or general education degree (GED) required.
• Minimum one-year related experience preferred.
• An equivalent combination of education, training, and experience.
• Demonstrates good organizational, interpersonal, leadership and communication skills.
• Knowledge of Medicare Advantage Guidelines per CMS Chapter 2, and knowledge of transactions between CMS and health plans.
• Excellent oral and written communication skills including good grammar, voice, and diction.
• Able to read and interpret documents.
• Proficient in MS Office with basic computer and keyboarding skills (40wpm).
• Detail oriented and highly organized.
• Excellent customer service skills (friendly, courteous, and helpful).