Enrollment Representative Senior
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.
ABOUT UCAREAt UCare, we deliver high-quality health coverage and services to help members of all ages maintain and improve their health. It's a big job that takes innovative ideas, strategic partnerships, and a commitment to doing the right thing. Above all, it takes a compassionate team that is dedicated to making a real difference in the lives of our members and our communities.WORKING AT UCAREWorking at UCare is more than just a career; it's a mission. A mission that defines us as professionals, unites us as an organization, and shapes how we interact with our members and each other. Our values of integrity, community, quality, flexibility, and respect permeate every aspect of our organization - from who we are and how we act, to what we do and how we do it. We owe our continued success to our employees who proudly embody our mission and values in everything they do. ENROLLMENT REPRESENTATIVE SENIORPosition DescriptionThis position is responsible to ensure daily and monthly Medicare and Medicaid enrollment files run and error reports are worked timely and accurately. Manage other lines of business. Manage the daily feeds from IKA and the monthly feeds from the State. Manage the monthly DHS files. Ensure timely and accurate data is submitted to the third party administrator of UCare Pharmacy membership. Back-up for Exchange duties including processing daily MNSure files, work in queues and complete/reconcile compares to ensure that systems match.·Verify and work daily enrollment reports from the IKA systems and monthly state membership files. Running the 2320 process for IKA HIX.·Load enrollment membership files for 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 queues are empty at the end of each day. Work 21 day process daily including member contact for missing information.·Process MSHO and Connect enrollment forms, fax and mail to DHS, maintain file of forms received, verifying information on membership file, etc.·Reconcile DHS payments, monitor and assist Enrollment to resolve differences identified in the matching of the state DHS payment with the information in UCare's core operating system prepared by Health Care Economics (HCE).·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 system Mn-ITS, as needed.·Understand and follow detailed procedures to process new enrollments for UCare for Seniors and State Products. Including; adhering to CMS/DHS/MNSure regulations regarding the processing of enrollments, computer system verification of eligibility, batch enrollment forms, and collaborate with sales representatives, when necessary. Specific timelines and accuracy standards must be met.·Research and maintain member on review (MOR) and MNsure Hold members to ensure accuracy. Collaborate with billing to resolve discrepancies.·Manage standard reports i.e. HIX MNsure hold, Membership files and plan to plan updates and all other reports.·Research and sync ikaSystems and Amisys for Medicare and Exchange membership and work discrepancies.·Demonstrate and maintain a thorough working knowledge of CMS/MNSure guidelines, memos, and reporting requirements. ·Maintain an understanding of the core operating computer system and a comprehensive knowledge of the department.·Manage Service Forms requests and member correspondence. Inform supervisor of trends/issues and assist in the development of potential solutions.·Manage standard reports i.e. Alt Provider, Spilt Spans, RG field updates and other reports that are sent by HCE.·Maintain ESI eligibility updates for pharmacy. ·Complete Peer QA on a monthly tracking.·Other projects and duties as assigned.EducationTwo year degree in business or related field; equivalent experience may be considered in lieu of degree.Required ExperienceThree year experience in health care, HMO or insurance field. Proficiency in Microsoft Word, and Excel. Data entry experience.Preferred ExperienceKnowledge of Medicare, Exchange and or Medicaid enrollment experience. THE UCARE DIFFERENCEUCare is proud to be a recognized Star Tribune Top Workplace for the 8th consecutive year. As a part of our collaborative team, you'll experience the rewards that come with helping others and seeing the positive results of your hard work. We value and respect each individual's ideas and contributions, and give you the freedom to grow both personally and professionally. We are centrally located, and offer onsite education, equipment and wellness resources, a myriad of volunteer activities, and a number of other rewards. If you're looking for a welcoming environment that celebrates what you have to offer, helps you build on your strengths, and gives you the opportunity to truly make a difference, we invite you to apply. 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.