Join us in our mission to transform healthcare! RxAdvance, now doing business as nirvanaHealth, is committed to bringing the art of possible to the payer and PBM industries, which is why we strive to invest in our employees throughout all stages of life. Success radiates through all levels of employees here, with competitive benefits, a strong focus on employee wellness, and optional education courses offered through UDEMY: we aim to support all aspects of employee growth.

Job Summary:

The Medicare Enrollment Specialist is responsible for the enrollment and disenrollment process for Medicare Advantage Plans. They will provide key support across the organization in areas including but not limited to eligibility, billing, general operations, and data management.

Job Responsibilities (but not limited to):

• Process enrollments and disenrollments, while providing key support across the organization to other departments involved in the eligibility.
• Document pertinent information enabling tracking of group/subscriber/member and eligibility and adheres to internal and external SLA’s.
• Excellent follow up and customer service to the members of the plans that we service while following CMS Medicare regulatory and eligibility requirements.
• Educate consumers who contact nirvanaHealth about Medicare products of the plans we are servicing.
• Provide knowledgeable response to internal and external inquiries and concerns regarding enrollment and billing including, but not limited to, qualifying events, policies and procedures, ID cards, letter correspondence (including Outbound Education and Verification), selection of primary care physician, premium invoices, payment inquiries and general eligibility and financial maintenance.
• Complete work accurately and timely to remain in compliance with DOI, CMS, and EOHHS regulations.
• Experience with CMS interfaces and systems for managing the Medicare enrollment functions.
• Develop a deep level of trust for Medicare members, understanding their needs, engaging the member on how the plan can best support them & their families, and orchestrating the initial enrollment with our team.
• With speed, accuracy, and integrity, ensure that enrollee data for Medicare Advantage, Medicare Supplement, and any future regulatory products is entered into nirvanaHealth’s system.
• Reconcile membership and billing reports as required by CMS, MassHealth and Employer groups (both automated and manual) to ensure accuracy of information.
• Appropriately escalates concerns when necessary and follows issues through to closure.
• Responsible to process payment files received from online payment vendor.
• Analyze/reconcile receivables balance for Regulatory products to identify problems with payments and/or impose the delinquency process.
• Processes all transactions related to customer data in a timely and accurate manner. Escalates inventory backlog daily
• Knowledgeable of plan policies, protocols, and procedures.

Qualifications:

Education and/or Training:

• High School Diploma or equivalent degree required.
• Bachelor’s degree is preferred, or equivalent relevant experience in Medicare Enrollment Services.

Professional Experience:

• 3 – 5 years of Medicare enrollment experience preferred.
• Prior experience working in a health plan is preferred.
• Knowledge of Medicare eligibility, as well as the Medicare Advantage Prescription (MA-PD) enrollment processing required.
• Excellent communicator with an uplifting, and personable manner with outstanding phone etiquette.
• Excellent written communication skills with success in providing notes, updates, and written communications via computer systems.
• Excellent data-entry skills and proven ability to navigate multiple computer screens.
• Must be able to multi-task and prioritize those tasks.

Technical/Specialized Skills:

• Must have the ability to analyze various situations and be able to make independent decisions on best practices in the interest of the members and the health plan.
• Tenacious problem solver, with demonstrated capacity to embrace complex problems and arrive at effective solutions in a timely manner.
• Requires ability to work in a fast-paced environment with multi-disciplined staff.
• Basic level PC skills Required (for example: start up and shut down computer, use mouse to point and click, start, and close programs, switch between programs, save files, print documents and/or access information on-line).
• Communicate effectively in writing and verbally.
• Basic or higher understanding of Microsoft Office.

Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Flexible schedule
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Parental leave
• Professional development assistance
• Vision insurance

Schedule:

• 8 hour shift

Ability to Relocate:

• Tampa, FL: Relocate before starting work (Required)

Work Location: In person