Health Care that Starts with You!
Join a truly mission-driven organization! Independent, nonprofit UCare is recognized as one of the Minnesota’s leading health plans. We provide more than 225,000 members across Minnesota and western Wisconsin with the health coverage plans and services they need to maintain and improve their health. The innovative coverage we create makes a difference for Medicare-eligible individuals, individuals and families enrolled in Minnesota Health Care Programs, such as MinnesotaCare and Medical Assistance, and disabled adults with special health care needs. UCare is growing in size, membership, products, geographic coverage, and employees. We’re an organization that’s going places. Be part of a team that cares about you, be part of UCare.
The Enrollment Representative is responsible to ensure daily and monthly Medicare and Medicaid enrollment files run and error reports are worked timely and accurately. Manage all other contracted business, Health Traditions/Portico from an enrollment perspective. Manage the daily feeds from Ika and the monthly feeds from the State. Ensure timely and accurate data is submitted to the third party administrator of Ucare Pharmacy membership.Specific duties and responsibilities include:
- Verify and work daily enrollment reports from the ika systems and monthly state membership files.
- Load enrollment membership files for all products, investigate and resolve errors to ensure members are accurately enrolled. Ensure accurate and timely submission of membership information through submission of OCR files to Ika systems to CMS. Ensure ques are empty at the end of each day. Work 21 day process daily including member contact for missing information.
- Process MSHO enrollment forms, fax and mail to DHS, maintain file of forms received, verifying information on membership file, etc.
- Understand eligibility and coverage of enrollees through knowledge of contracts, policies and procedures. Demonstrate and maintain a thorough working knowledge of claims, authorization screens, and CMS guidelines. Verify member eligibility by using the State’s electronic verification system, EVS, as needed.
- Understand and follows detailed procedures to process new enrollments for UCare for Seniors and MSHO. Including: adhering to all CMS/DHS regulations regarding the processing of enrollments, making computer system verification of eligibility, batching enrollment forms, and work with sales representatives, when necessary. Specific timelines and accuracy standards must be met.
- Demonstrate and maintain a thorough working knowledge of CMS guidelines, memos, and reporting requirements.
- Maintain an understanding of the core operating computer system and a comprehensive knowledge of the Enrollment and Billing and Accounts Receivable Subsystem as it relates to the Membership Accounting Procedures.
- Maintain record of OOA members to ensure compliance with CMS regulations, follow-up and subsequent disenrollment from plan. Maintain accurate records of institutional members by adding and removing members from the PermInst tracking database when appropriate. Maintain ProCare member eligibility.
- Manage CSF requests and member correspondence. Inform supervisor of trends/issues and assist in the development of potential solutions.
- Manage standard reports i.e. the monthly Birthday report, Alt Provider and RAPS reports.
- Other projects and duties as assigned.
High school graduate or equivalent required. Associate degree in health related field or liberal arts preferred, relevant work experience considered in lieu of degree. One year experience in health care, HMO or insurance field required. Proficiency in Microsoft Word, and Excel. Data entry experience required. Knowledge of Medicare and or Medicaid enrollment experience preferred.
As an Equal Opportunity/Affirmative Action employer, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.
Enter a highly collaborative environment where people are truly engaged, and feedback is valued. You’ll enjoy a competitive salary and benefits, as well as a host of other perks, including a nationally recognized wellness program, and a bright, open, award-winning office space in Northeast Minneapolis—just minutes from major freeways and retail centers.
At UCare, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.