Job Information
UCLA Health Medicare Advantage Sr. Enrollment Representative in Los Angeles, California
Description
As a member of the Medicare Advantage Operations team, the Senior Medicare Advantage Enrollment Representative plays a pivotal role in processing all enrollment, disenrollment, and cancellation requests. This position requires a deep understanding of Medicare Part D programs and meticulous attention to detail to ensure accurate and timely processing. The ideal candidate will possess excellent communication skills and the ability to collaborate with various departments to address member issues promptly and implement ADHOC resolutions to sustain quality member care.
Responsibilities include:
Ensure accurate completion of enrollments in accordance with CMS and other Managed Care Guidelines
Process all Enrollment, Disenrollment, cancellation requests, reinstatements and managed retro reconciliation files or requests
Reconcile daily Transaction Reply Report (TRR) and retro reconciliation files
Maintain oversight on the accuracy and timeliness of acknowledgment notices sent to members
Maintain open lines of communication with various departments to resolve member issues promptly and implement ADHOC resolutions to sustain quality member care
Understand all aspects of enrollment operations, Medicare membership enrollment, reconciliation, and benefits coordination operations
Hands-on experience with 834 EDI, State (CA DHS), and CMS files
Salary Range: $28.23 - $40.44 Hourly
Note: This posted position is 1 of 3 positions available for hire. All applicants will apply through this requisition and if selected will be hired into one of the available positions.Qualifications
We're seeking detail-oriented, self-directed professional with:
High School Diploma or equivalent work experience required
Required a minimum of three years' experience in a Medicare health plan or Managed Care - Enrollment, Disenrollment and Reconciliation
Robust knowledge of Medicare and CMS enrollment and billing regulatory requirements
Initiative, problem identification, resolution and analytical skills are essential
Excellent oral and written communication skills are required
Ability to modify and adapt operational procedures to changing operational needs
Ability to develop, implement, and evaluate methods and systems to improve efficiency
Proven skills to lead and facilitate cross-functional workgroups and other meetings
Ability to work as part of a team, collaborating with colleagues
Ability to analyze and organize complex federal and private insurance regulations
Ability to travel/attend off-site meetings and conferences
UCLA Health welcomes all individuals, without regard to race, sex, sexual orientation, gender identity, religion, national origin or disabilities, and we proudly look to each person’s unique achievements and experiences to further set us apart.
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