Enrollment Analyst - ACA Enrollment

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Come join our Peak Health team at WVU Medicine as an Enrollment Analyst, contributing to the foundation for an innovative, new health plan. This position will report to the Enrollment Manager, playing a unique and important role in our mission to change healthcare for the better.
Experience in the healthcare industry and critical thinking skills will help the organization build an effective and efficient enrollment team. The enrollment team will review, execute, and oversee the processing of member enrollment application information for Peak Health ’s Plan Suite. The Enrollment Analyst role will have responsibilities pertaining to Medicare and ASO business functions. This role will be responsible for managing weekly enrollment files, daily processing of Medicare applications, reconciliation of membership and coverage records, overseeing member record maintenance, complying with submissions to CMS, and work closely with the leadership team to create and maintain training programs for enrollment specialists.
This role will be responsible for completing inventory in a production environment, as well as offline projects. An individual who is self-guided and able to work with minimal supervision will be successful in this role. MINIMUM QUALIFICATIONS :

EDUCATION, CERTIFICATION, AND/OR LICENSURE:
1. High school Diploma or equivalent
EXPERIENCE:

1. Three (3) years of experience working with medical or institutional data entry.

2. Three (3) years of customer service experience.

3. Two (2) years of Medicare eligibility and Medicare Enrollment processing experience

PREFERRED QUALIFICATIONS :

EXPERIENCE:

1. Four (4) years of Medicare Enrollment processing and customer service experience.

2. Familiarity with Medicare elections, transaction codes, and reconciliation operations.

3. Familiarity with managing late enrollment penalty (LEP) for MAPD enrollees.

4. Familiarity with navigating CMS tools and resources, particularly the MARx website.

5. At least one (1) year of experience with system/user acceptance testing.

6. At least one (1) year of experience with developing and delivering trainings.

7. Familiarity with Enrollment Data Validations (EDVs) and REED Submissions.
8. Previous experience in EMR systems.

CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.

1. Determine accuracy and completions of member form information. Entry/verifies form data.

2. Resolves enrollment issues to assure efficient and seamless member experience.

3. Maintains member enrollment records annually, indicating changes, updates, and outreach as required.

4. Meets all production and quality standards, maintaining workqueues according to department standards.

5. Effectively communicates with internal and external staff.

6. Elevates issues to next level of supervision, as appropriate.

7. Ensures accuracy of data entered and record maintenance.

8. Attends all required training classes, demonstrating proficiency and ability to learn.

9. Manages coordination of benefits (COB) on member records, running real-time eligibility queries, as needed.

10. Develops and Delivers department trainings to new hires, including managing the resources available to staff.

11. Participates in system testing for any development rollouts.

12. Participates in department planning to ensure a successful Open Enrollment.

13. Fully owns the enrollment data validation (EDV) monthly processes and REED