Enrollment Specialist (bilingual)

POSITION SUMMARY:

 This position ensures the accurate and timely input and updating of enrollments, disenrollment and other data related to the status of members for electronic submission to and receipt from HCFA.  The incumbent will process enrollment and disenrollment changes and correction records based on Reply Listing information and other reports as applicable.  The incumbent will follow the Standard Operating Procedures for Medicare+Choice Enrollment functions.  The incumbent is required to provide reports on enrollment statistics.

 

ESSENTIAL DUTIES AND RESPONSIBILITIES:

 

§ Completes data entry of enrollments, disenrollments and other Special Status information related to members.

§ Analyze and make corrections to enrollments, disenrollments and other records based on the Reply Listing and other reports.

§ Use the following systems to access the HCFA managed care systems – Managed Care Option Information System (McCoy) and the Group Health Plan Report Output User Communication Help (GROUCH) System – to view reports, check records and perform other Enrollment functions.

§ Prepare enrollment reports based on business need and management request.

§ Other duties as assigned

 MINIMUM QUALIFICATIONS:

 

High school diploma or General Education Degree (GED) preferred

 

  KNOWLEDGE, SKILLS AND ABILITIES:

 

§ Knowledge of Medicare membership information

§ Minimum of three years of customer service experience

§ Minimum of three years experience in health care, social services or with Medicaid or Medicare recipients

§ Excellent listening, organizational, attention to details and analytical skills required

 

 

§ Ability to meet deadlines and manage multiple priorities

§ Effectively adapt and respond to complex, fast-paced, rapidly growing, and results-oriented environment

§ Ability to handle confidential information with professional ethics and integrity

§ Solid basic mathematical aptitude

§ Proficiency in Microsoft applications specifically Microsoft Excel and Microsoft Access.

§ Data entry skills required. Database software knowledge highly preferred.

§ Clear, concise and persuasive verbal and written communication skills.  Courteous and professional phone manner. 

§ Ability to communicate effectively with diverse and sometimes irate individuals.

§ Ability to handle calmly and efficiently situations ranging from routine to urgent. Must be able to positively interact with members, co-workers and external regulatory agencies, specifically the Health Care Financing Administration (HCFA) and the Center for Health Dispute Resolution (CHDR).

§ Requires excellent conflict resolution skills

§ Makes decisions on what needs to be done based on clearly established guidelines.

§ Must be able to work long hours to meet critical deadlines.

§ Ability to sit at workstation for extended periods, using computer keyboard and visual display terminal