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

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