Enrollment Specialist - Medicare & Exchange (Temporary) - 4 Month Assignment
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 SPECIALIST - MEDICARE & EXCHANGE (TEMPORARY) - 4 MONTH ASSIGNMENTPosition DescriptionThis position is responsible for leading the daily file processing for Medicare and Exchange business. Ensure daily and monthly Medicare, Medicaid and Choices enrollment files run and error reports are worked timely and accurately. Manage the daily feeds from IKA Gateway, IKA HIX and the monthly feeds from the State. Ensure timely and accurate data is submitted to the third party administrator of UCare Pharmacy membership. Compare and reconcile UCare's operating systems - syncing ikaSystems and Amisys for Medicare and Exchange. Identify discrepancies and work with billing to resolve differences.·Verify and work daily enrollment reports from the IKA systems and monthly state membership files. Running the 2320 process for IKA Medicare and IKA HIX.·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 queues are empty at the end of each day. Work 21 day process daily including member contact for missing information.·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 follows detailed procedures to process new enrollments for UCare for Seniors and Choices. Including: adhering to all CMS/MNsure 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.·Research and maintain member on review (MOR) and MNsure Hold members to ensure accuracy. Work with billing to resolve discrepancies.·Research and sync ikaSystems and Amisys for Medicare and Exchange membership and work discrepancies.·Maintain understanding of the Enrollment and Billing subsystems as it relates to the Billing and Enrollment procedures.·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 Enrollment and Billing 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. HIX MNsure hold, Membership files and Plan to plan updates and all other reports.·Complete Peer QA on a monthly tracking. ·Maintain ESI eligibility updates for pharmacy across all lines of business. ·Other projects and duties as assigned. EducationFour year degree in business or related field; equivalent experience may be considered in lieu of degree.Required ExperienceThree years' experience in health care, HMO or insurance field. Intermediate in Microsoft Word, and Excel. Critical thinking and analytical experience.Preferred ExperienceKnowledge of Medicare, Choices and 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.