Enrollment/Disenrollment Specialist, South San Francisco, CA
(***Fluency in Spanish required***)
The Health Plan of San Mateo (HPSM), a managed care health plan, seeks a full time Enrollment/Disenrollment Specialist to perform accurate processing of enrollment, disenrollment and reconciliation transactions for members of CareAdvantage, the Health Plan of San Mateo’s Medicare Advantage/Prescription Drug Plan (MA/PDP). This will position will ensure that transactions will be processed in accordance with CMS guidelines for Medicare Advantage plans and Medicare-Medicaid Plans (MMP). The essential duties & responsibilities will include the following:
- Process CareAdvantage enrollment transactions in accordance with the Centers for Medicare & Medicaid Services (CMS) guidelines, including timeliness of completion.
- Contact members to verify accuracy of enrollment form information. Obtain evidence of Medicare and Medi-Cal coverage.
- Enter and maintain member information in the HPSM database including special flag status, e.g. Medicare Secondary Payer (MSP) and hospice. Reconcile member information between HPSM’s database and Medicare/Medi-Cal information which may include submission of retroactive requests to the CMS Retro Processing Contractor.
- Submit enrollment information to CMS within required timelines.
- Investigate and correct enrollment information that has been rejected by CMS due to correctable errors.
- Send letters to members advising them of enrollment in CareAdvantage.
- Process voluntary and involuntary disenrollment and related transactions in accordance with CMS guidelines, including timeliness of completion.
- Contact members and/or their representatives to verify disenrollment.
- Document the reasons for disenrollment including loss of Medi-Cal eligibility, move out of area.
- Update the HPSM databases to reflect the enrollment/disenrollment and the effective dates.
- Assure that the proper information is transmitted to CMS within required timelines.
- Send letters to members advising them of disenrollment from CareAdvantage.
- Professionally represent Plan and Department in internal and external Meetings.
- Monitor internal and external reports to maintain correct member information and eligibility which also includes adhoc reports.
- Work closely with the CareAdvantage Navigators in resolving member issues.
- Work and complete various CMS audits as well as HPSM internal audits to assure quality assurance and timeliness of transactions.
Education and Experience: Equivalent to a high school diploma or GED required. Three (3) years of experience working with persons with disabilities and/or seniors in a medically related field (e.g., physician office, HMO, IPA). Experience in managed care enrollment/disenrollment and phone-based customer service highly preferred.
Knowledge of: Medicare, Medi-Cal and Managed Care. Database maintenance. Personal computers and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, Access and PowerPoint.
Ability to: Organize work. Demonstrate excellent oral and written communication skills with various audiences and individuals of diverse backgrounds particularly when dealing with an elderly and/or medically fragile population. Perform problem research, use analytical skills, and effectively influence positive outcomes. Develop and maintain strong professional relationships with a diverse range of people.
Starting Compensation Range: Between $20.99 /per hour- $28.86/per hour, depending on experience.
Other: ***Fluency in Spanish is required for this position***
Benefits Information: HPSM offers extremely competitive benefits. Check them out at: https://www.hpsm.org/abouthpsm/employment-opportunities.aspx (Under Employee Benefits Tab)
Application Process: To apply, submit a resume and cover letter with salary expectations to: Health Plan of San Mateo, Human Resources Department, 801 Gateway Blvd., Suite 100, South San Francisco, CA 94080 or via email: email@example.com or via fax: (650) 616-8039. File by: Continuous until filled. EOE