Healthcare Enrollment Representative
Beacon Health Solutions
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Tampa, FL 33609
Healthcare Enrollment Representative
Tampa, FL
Beacon Health Solutions , a cornerstone in the Tampa Healthcare landscape for over a decade, is searching for a Healthcare Enrollment Representative to join our Enrollment & Member Services team. The Healthcare Enrollment Representative is responsible for performing duties related to enrollment of Medicare and Medicaid beneficiaries. The Healthcare Enrollment Representative is required to make eligibility determinations based on CMS (Part A/Part B Eligibility) in accordance with the application election period guidelines.
Principal Duties and Responsibilities:
• Ensure the accuracy and timeliness of processing enrollments and disenrollment in compliance within Medicare and Medicaid regulations and Beacon policies and procedures
• Demonstrates the skills and ability to analyze information to make appropriate decisions regarding eligibility in compliance with regulations and governance set forth by the Centers for Medicare and Medicaid Services (CMS) and Beacon Health Solutions
• Process daily applications and disenrollment received via the various sources in the membership systems for daily transmission to CMS
• They are also responsible for processing new or maintenance updates to enrollment eligibility in the membership systems
• To accurately identify appropriate election period based upon analysis of beneficiary/member history and regulatory guidance
• Assist with daily reviews and processing of the Daily Transaction Reply Report (DTRR)
• Assist with tracking and oversight of CMS OEC, Auto and Facilitated web-based files
• Generate appropriate correspondence to outreach to members request, as necessary
• Performs root cause analysis to determine issues related to member inquiry and or system errors
• Initiate phone interactions with members to issue resolution
• Must adhere to and keep up to date with new regulations and guidance provided during training updates
• Interacts with both internal and external customers to address and resolve inquiries or complaints and achieve CMS requirements and Client’s Service Level Agreements (SLAs)
• Attention to detail is critical to the success of this position, with skills in customer orientation
• Accurately enter COB for timely and accurate claims adjudication
• Assist mailroom with processing Return Mail
• Adhere to productivity, quality and compliance expectations
• Identifies issue trends and opportunities for improvement
• Be a supportive and collaborative team member
Experience and Education:
• High School Diploma
• Knowledge of Medicare Advantage Guidelines per CMS Chapter 2, and knowledge of transactions between CMS and health plans
• 1+ years’ claims experience
• 1+ years’ experience with Medicaid, Medicare preferred
• Strong knowledge/Proficiency with MS Office
Job Type: Full-time
Benefits:
• 401(k)
• Dental insurance
• Employee assistance program
• Health insurance
• Life insurance
• Paid time off
• Vision insurance
Schedule:
• Monday to Friday
Experience:
• Medicare Advantage Guidelines: 2 years (Preferred)
• Medicaid/Medicare: 2 years (Preferred)
• Knowledge of Transactions between CMS & Health Plans: 2 years (Preferred)
Location:
• Tampa, FL 33609 (Required)
Work authorization:
• United States (Required)
Company's website:
• www.beaconh.com
Work Remotely:
• No