The role is responsible for the timely and accurate resolution of discrepancies identified in the Enrollment and Reconciliation processes. The analyst will review documentation, work items in queues and correct errors, identify trends and document resolutions based on the Standard Operating Procedures.
ESSENTIAL DUTIES AND RESPONSIBILITIES
- Process queue items, inter-departmental and customer requests timely and accurately
- Review incomplete and pending enrollment applications and disenrollment forms for correction and submission to Centers for Medicare & Medicaid Services (CMS)
- Review and complete Late Enrollment Penalty (LEP) Attestations
- Review and complete Other Health Insurance (OHI) verification and error correction
- Review and create retro processing packets to be submitted to the CMS Retro Processing Contractor (RPC)
- Researching and correcting errors, discrepancies, and rejected transactions received from:
- CMS on the Daily Transaction Reply Report (DTRR)
- CMS Daily and Monthly Reconciliation queues
- Daily and Monthly Pharmacy Benefit Manager (PBM)
- Monthly MMR, PWR, LIS History and LEP Reconciliation
- Daily OHI/COB Rejections
- Monthly review and preparation of the CMS Enrollment Data Validation file and submissions
- Working understanding of Centers for Medicare & Medicaid Services (CMS) guidance
- Conform with and abide by all regulations, policies, work procedures and instructions
- Meet CMS guidelines and client Service Level Agreement (SLA) requirements through the proper handling of transactions
- Perform outbound calls to customers or other entities as permitted to complete processing of enrollment, disenrollment and reconciliation transactions
- Make appropriate system corrections and escalate transactions that are unable to be corrected
- Prepare reports as requested by management
- Perform other duties and responsibilities as required
EDUCATION AND EXPERIENCE
- High school diploma required; Associates Degree or higher preferred
- Minimum 2 years Health Plan Operations experience including; Customer Service, Enrollment, and or Claims processing
- Working knowledge of MSOffice (Word, Excel, Outlook)
Job Type: Temporary
Pay: $17.75 per hour
Work Location: Remote
