Commercial Enrollment Specialist II

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Overview HealthEdge ® offers AI-powered operational infrastructure for health insurance companies, guaranteeing an enduring financial edge in an increasingly competitive market. We're experiencing strong market momentum, with a growing number of health plans choosing HealthEdge to modernize their operations and compete more effectively. As we expand, we're investing in the people who power that growth, making this a pivotal moment to join us and shape the future of healthcare technology. Learn more at HealthEdge .com. HealthEdge is looking for an Enrollment Specialist II, reporting to the Enrollment Manager. The Enrollment Specialist II is responsible for ensuring accurate enrollment including billing and maintenance of member data by researching and resolving enrollment and billing discrepancies. The role is also responsible for reconciling and correcting enrollment-related issues by building case files that are sent to the CMS Contractor for approval and resolution. As an Enrollment Specialist II at HealthEdge , this is your opportunity to Be responsible for preparing, processing, and maintaining enrollment and disenrollment requests Be responsible to verify and maintain all applicable eligibility requirements Be responsible to review and process CMS transactions Be responsible for reviewing Medicaid eligibility and completing verification processes Be responsible to resolve enrollment system rejections based on regulatory and client specified guidelines Be responsible to reconcile membership reports as required by CMS Be accountable to attend and successfully complete the trainings scheduled by the client and employer Mentor junior members of the team Collaborate with other team members on special projects; special projects can include process documentation development, training, quality reviews for the client(s), or any other project as determined by management Establish and maintain an appropriate level of communication with management to address issues and concerns and take preventive measures that ensure case accuracy and quality Participate in projects as assigned by management Perform other duties as assigned You bring: High school degree required 3-5 years of professional experience in processing Medicare enrollment transactions A thorough understanding of Medicare Advantage products, CMS transaction files, and the corresponding enrollment-related guidelines; Medicaid enrollment experience a plus Experience with CMS interfaces and systems for managing the Medicare Advantage enrollment and billing functions Ability to analyse enrollment reconciliation data and report SLAs, KPIs, and other operations reports and present findings in a structured way Willingness to learn Team collaborator Strong work ethic For this role, we value: The ability to adapt quickly to a challenging environment A self-starter and quick learner Ability to collaborate Geographic Responsibility: Remote, US Type of Employment: Full-time, permanent Work Environment: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job: The employee is occasionally required to move around the office. Specific vision abilities required by this job include close vision, color vision, peripheral vision, depth perception, and ability to adjust focus. Work across multiple time zones in a hybrid or remote work environment. Long periods of time sitting and/or standing in front of a computer using video technology. May require travel dependent on company needs. The above statements are intended to describe the general nature and level of the job being performed by the individual(s) assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skills required. HealthEdge reserves the right to modify, add, or remove duties and to assign other duties as necessary. In addition, reasonable accommodations may be made to enable indi

概述 HealthEdge ® 为健康保险公司提供人工智能驱动的运营基础设施，确保在日益激烈的竞争市场中保持持久财务优势。我们正经历强劲的市场势头，越来越多的健康计划选择 HealthEdge 来实现运营现代化并更有效地竞争。随着我们的扩张，我们正在投资于推动这一增长的人才，此刻正是加入我们并塑造医疗保健技术未来的关键时机。欲了解更多信息，请访问 HealthEdge .com。HealthEdge 正在招聘一名注册专员 II，向注册经理汇报。注册专员 II 负责通过研究和解决注册与账单差异，确保包括账单和会员数据维护在内的准确注册。该角色还负责通过建立案件档案并发送至 CMS 承包商审批和解决，来核对和纠正与注册相关的问题。作为 HealthEdge 的注册专员 II，这是您的机会： 负责准备、处理和维护注册与退保请求 负责验证和维护所有适用的资格要求 负责审查和处理 CMS 交易 负责审查 Medicaid 资格并完成验证流程 负责根据监管和客户指定的指南解决注册系统拒绝问题 负责按 CMS 要求核对会员报告 负责参加并成功完成客户和雇主安排的培训 指导团队初级成员 与其他团队成员合作开展特殊项目；特殊项目可包括流程文档开发、培训、客户质量审查或管理层确定的任何其他项目 与管理层建立并保持适当级别的沟通，以解决问题和疑虑，并采取预防措施确保案件准确性和质量 参与管理层分配的项目 履行其他分配职责 您需要具备： 高中文凭 required 3-5 年处理 Medicare 注册交易的专业经验 对 Medicare Advantage 产品、CMS 交易文件及相应注册相关指南有透彻理解；有 Medicaid 注册经验者优先 具有使用 CMS 接口和系统管理 Medicare Advantage 注册和账单功能的经验 能够分析注册核对数据并报告 SLA、KPI 和其他运营报告，并以结构化方式呈现发现 愿意学习 团队合作者 强烈的职业道德 对于这个角色，我们重视： 快速适应充满挑战环境的能力 自我驱动者和快速学习者 协作能力 地理责任：远程，美国 雇佣类型：全职，永久 工作环境：此处描述的身体要求代表员工成功履行本职位基本职能所必须满足的要求：员工偶尔需要走动。本职位所需的特定视觉能力包括近距离视力、色觉、周边视力、深度感知和调整焦距的能力。在混合或远程工作环境中跨多个时区工作。长时间坐在和/或站在电脑前使用视频技术。可能需要根据公司需要出差。上述陈述旨在描述分配到此职位的个人所执行工作的一般性质 and 级别。它们并非旨在详尽列出所有职责、责任和所需技能。HealthEdge 保留修改、增加或删除职责以及分配其他必要职责的权利。此外，可能会提供合理便利以使个人

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