As a member of the Medicare Advantage Operations team, the Medicare Advantage Enrollment Representative plays a crucial role in the enrollment process by reviewing and submitting enrollment requests.
You will:
- Review and submit Enrollment requests received as well as maintaining accuracy and timeliness of acknowledgment notices to members
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Maintain open lines of communication with various departments to resolve member issues and implement ADHOC resolutions to sustain quality member care
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Use Key Performance Indicator’s (KPIs) to identify trends and risks; manage service and Operating Level Agreement metrics/reporting and present findings
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Review Medicaid Aid codes and their corresponding Medicaid level and interpretation for department processes.
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Ensure quality and compliance to meet applicable guidelines; ensure timely, accurate and complete submissions to CMS – Medicare
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Identifies continuous improvement initiatives to streamline processes, reduce member complaints and improve the overall member experience
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Ensure that prospective enrollees are appropriately screened to meet eligibility requirements within regulatory timelines
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Work closely with the Sales and Compliance teams to ensure timely submissions and resolution of eligibility issues, as well as departmental goals and quality goals are met
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Ensure the required member mailings are sent in a timely fashion
