Roles & Responsibilities:
1. Essential Functions-
- Enter enrollees into system monthly
- Submit Enrollment Files to CMS monthly
- Place enrollment file on FTP site monthly
- Check DTRR reports daily
- Follow-up on any issues appearing on the DTRR
- Place MMR in Excel on FTP site
- Submit MMRs, HCC MORs & Rx HCC MORs to PDAC monthly
- Submit retroactive adjustments to Reed & Associates or CMS regional office as needed
- Submit attestation information to clients monthly
- Completes Enrollment Data Validation (EDV) Audits
- Follow up on enrollment issues
- Communicate any outstanding enrollment issues to clients
- Review the A/R aging each week
- Coordinate follow-up with the Accounting department for any A/R balances
2. Additional Functions-
- Assists with special projects, as requested
- Communicates clearly and concisely, with sensitivity to the needs of others
- Maintains the confidentiality of all company procedures, results, and information about participants, clients, providers and employees
- Maintains courteous, helpful and professional behavior on the job; displays a willingness and ability to be responsive in a warm and caring manner to all customer groups. Consistently cooperates and supports organization in problem solving issues.
- Establishes and maintains effective working relationships with co-workers
- Follows all Policies and Procedures and HIPAA regulations
- Participates in any recommended or required training sessions
- Maintains a safe working environment
Knowledge, Skills and Abilities:
- Educational requirements include a high school diploma or equivalent.
- Three years of experience in a health plan management or insurance company, or similar experience, is required. Prior experience working with enrollments is strongly preferred. A working knowledge of Medicare is required.
- Current knowledge and understanding of Medicare regulations related to PACE health plan management is helpful.
- Knowledge and experience using Excel, Microsoft Word and ten-key efficiency; ability to quickly adapt to new systems
- Strong knowledge of current computer technology, including the use of computers, printers, computerized file structures and associated software
- Skilled in establishing and maintaining effective working relationships with co-workers and clients
- Skilled in problem resolution; recommends suggestions to increase accuracy and/or efficiency
- Detail-oriented with ability to focus on projects for extended periods
- Ability to work independently, seeking supervision as needed
- Ability to communicate professionally, clearly and effectively, verbally and in writing
- Ability to have superior attendance to effectively fulfill all functions of the position
- Ability to independently follow through on assigned tasks, without prompting
- Ability to prioritize effectively
- Ability to consistently multitask