Description
UCLA HEALTH
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Description
As a member of the Medicare Advantage Operations team, the Medicare Advantage Enrollment Representative plays a crucial role in the enrollment process by reviewing and submitting enrollment requests.
You will:
- Review and submit Enrollment requests received as well as maintaining accuracy and timeliness of acknowledgment notices to members
- Maintain open lines of communication with various departments to resolve member issues and implement ADHOC resolutions to sustain quality member care
- Use Key Performance Indicator’s (KPIs) to identify trends and risks; manage service and Operating Level Agreement metrics/reporting and present findings
- Review Medicaid Aid codes and their corresponding Medicaid level and interpretation for department processes.
- Ensure quality and compliance to meet applicable guidelines; ensure timely, accurate and complete submissions to CMS – Medicare
- Identifies continuous improvement initiatives to streamline processes, reduce member complaints and improve the overall member experience
- Ensure that prospective enrollees are appropriately screened to meet eligibility requirements within regulatory timelines
- Work closely with the Sales and Compliance teams to ensure timely submissions and resolution of eligibility issues, as well as departmental goals and quality goals are met
- Ensure the required member mailings are sent in a timely fashion
Salary Range: $23.58 – $33.05/hourlyQualifications
We’re seeking detail-oriented, self-directed professional with:
- High School Diploma or equivalent experience required
- Experience in a Medicare or Managed Care environment, Member Enrollment and Billing experience preferred
- Ability to analyze and organize complex federal and private insurance regulations
- Working knowledge of Microsoft Office Suite (Excel, Word, and PowerPoint) and data visualization tools.
- Skill in prioritizing and performing a variety of duties within a system that has frequently changing assignments, priorities and deadlines
- Strong critical thinking and the ability to apply knowledge at a broad level is essential
- Reliability and compliance with scheduling standards