Enrollment Specialist

RxAdvance - Southborough, MA (30+ days ago)

Job Description:
Join our team! RxAdvance is a disruptive healthcare company that leverages technology to transform the pharmacy benefit management (PBM) industry. With guidance from visionary leaders, such as John Sculley, former Apple CEO, and Ravi Ika, RxAdvance CEO and Founder of ikaSystems, RxAdvance embraces innovation and entrepreneurial thought to define the future of healthcare.

RxAdvance is seeking a results-driven individual who will be working as part of an implementation team and is responsible for engaging new/existing client, understanding client’s eligibility information (layout, fields, and exchange), and act as a liaison for all enrollment and eligibility questions or concerns between RxAdvance and the health plan client. This Enrollment Specialist should be very comfortable working with data sets and will engage health plan client collaboratively in understanding clients’ business hierarchy to structure the plan hierarchy and configure it into Collaborative PBM Cloud . This individual will be responsible for overseeing the loading of the eligibility files, providing the client with error reports, and reconciling any errors from the load.

Review enrollment files and eligibility mapping to determine the client’s business hierarchy and structure the plan hierarchy

Liaise between RxAdvance and health plan clients’ teams to evaluate collected documents and rectify any identified discrepancies

Work with internal technical enrollment team to provide client support through timely error reporting and error resolution

Run test claims to ensure accuracy of member eligibility file loads

Prepare supporting documents to share with clients for sign-off

Work collaboratively with the implementation manager and database team to coordinate and ensure enrollment data integrity

Obtain and evaluate additional documentation from client as necessary

Basic Qualifications:
2-4 years of experience working in an operational role related to enrollment in a health plan or third-party administrator

Ability to work independently with minimal supervision

Strong problem-solving skills to detect and resolve errors in loaded files

Ability to analyze and comprehend eligibility files

Excellent verbal and written communication skills to provide error reports

Experience with SQL and relational databases is a plus

Prior Medicaid/Medicare/HIX and/or enrollment experience is preferred

PBM experience is preferred

Bachelor’s degree is required, degree in business or healthcare management fields are preferred