Humera is looking for an Enrollment Representative for our client in Minneapolis, an independent, nonprofit health plan provider. The candidate in this position will be responsible for ensuring that enrollment files run and error reports are worked timely and accurately. This is a long-term, contract opportunity!
Knowledge of Medicare, Choices and Medicaid enrollment experience
- Verify and work daily enrollment reports
- 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. 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
- Four year degree in business or related field; equivalent experience may be considered in lieu of degree
- Three years' experience in health care, HMO or insurance field
- Intermediate in Microsoft Word, and Excel. Critical thinking and analytical experience.