Enrollment Specialist iCare - Remote US

Profile

Description

iCare is seeking an Enrollment Specialist who will support the iCare enrollment processing duties for all lines of business including Medicare, Medicaid, Family Care Partnership (FCP) and BadgerCare Plus.

Responsibilities

The Enrollment Specialist is responsible for iCare enrollment processing activities, the preparation, distribution, and maintenance of reports including meeting various reporting requirements, and the resolution of enrollment/disenrollment issues. Other functions include maintenance of the iCare eligibility information for members, including coordination of benefits (COB), oversight of the systematic transmission of member specific enrollment files to and from the appropriate iCare vendors, oversight of the iCare enrollment mailbox, and the review of encounter errors.

Essential Duties and Responsibilities:

Enters iCare Medicare enrollment form information into ACT and interacts with iCare's Sales staff as needed on specific enrollment related situations.

Processes the iCare Medicare enrollment applications and forwards the iCare Medicare enrollments to Cognizant BMS Enrollment via ticketing system.

Downloads and reconciles CMS TRR; approves appropriate changes in the enrollment ODS database.

Reconciles 834 information for Medicaid and BadgerCare Plus; approves appropriate changes in the enrollment ODS database.

Enter FCP enrollments into the enrollment ODS database and interact with iCare FCP staff members, the Wisconsin Department of Health Services (DHS), Centers for Medicare and Medicaid (CMS) and other external resource centers as needed.

Alternate between Medicaid and Medicare enrollment functions and coordinate with various iCare departments accordingly.

Perform audits on enrollment transactions completed monthly to ensure quality.

Monitors the reporting requirements for Medicare and Medicaid enrollments and disenrollments to confirm they are met.

Resolves encounter errors given to them by the Finance Department.

Monitors enrollment department mailbox to process demographic updates, as well as handle any enrollment related inquiries.

Coordinate and perform COB validations, including daily inquiries from various iCare departments, as well as monthly files received from DHS/CMS and the external COB vendor.

Update ODS accordingly and ensure QNXT is properly updated as well.

Maintain iCare eligibility tables/data files and assure accuracy in enrollment reports and first-tier downstream related entities as identified in enrollment processes.

Identify, resolve and communicate eligibility issues through the proper resolution process with CMS, Cognizant, iCare staff and other related parties.

Assist in resolution of provider/enrollee complaints or appeals that relate to eligibility problems.

Required Qualifications:

Two (2) or more years' experience in the medical insurance, Medicare and/or Medicaid environment working with eligibility/enrollment information.

Knowledge of Medicare CMS eligibility information systems and/or Medicaid portals and in depth understanding of Medicare and/or Medicaid eligibility terms and processes.

Hands-on PC experience to include experience in data entry, word processing and spreadsheet applications. Demonstrated use of Microsoft Office applications including Excel, Word and Outlook.

Analytical skills and detail-oriented ability.

Must have the ability to provide a high-speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.

A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.

Satellite and Wireless Internet service is NOT allowed for this role.

A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.

Additional Information:

Workstyle: Home. Home workstyle is defined as remote but will use Humana office space on an as needed basis for collaboration and other face-to-face needs.

Typical Work Hours/Days: Monday through Friday; 8:30am - 5:00 pm (CST)

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.

Scheduled Weekly Hours

40

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

Company info

Humana Inc.
Website : http://www.humana.com