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 and or Medicaid enrollment experience
- 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, Connect and Connect+Medicare enrollment forms, fax and mail to DHS, maintain file of forms received, verifying information on membership file, etc.
- Perform reconciliation of all DHS payments, monitor and assist Enrollment with resolving differences identified in the matching of the state DHS payment with the information in our clients core operating system as prepared by Health Care Economics.
- 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 Seniors and State Products. Including: adhering to all CMS/DHS regulations regarding the processing of enrollments, making computer system verification of eligibility, batching enrollment forms, processing return mail 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 Department.
- Manage Service Forms requests and member correspondence. Inform supervisor of trends/issues and assist in the development of potential solutions.
- Create and Update Step by Steps.
- Complete Peer QA on a monthly tracking.
- Manage standard reports i.e. Alt Provider, Split Spans, RG field updates and all other reports that are sent by HCE.
- Maintain ESI eligibility updates for pharmacy.
- Other projects and duties as assigned.
- Two Year degree in business or related field; equivalent experience may be 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