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An Enrollment Specialist is a member of the Patient Engagement Specialist (PES) team, telephonically educating and enrolling patients in a Medicare-sponsored care coordination program designed to help the patient better manage their chronic illnesses (diabetes, high blood pressure, COPD, etc.
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2 years direct work experience in benefits administration, and experience with Ultimate Software (Ultipro) is preferred, including familiarity using an online benefits enrollment platform. Knowledge of pertinent federal and state regulations, filing and compliance requirements both adopted and pending affecting employee benefit programs, including ERISA, FMLA, ADA, ACA, Section 125, Workers' Compensation, Medicare, and Social Security and DOL requirements.
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Work with complex large-scale data sets from multiple systems of origin including Medicare, Medicaid, and CHIP enrollment and claims; CAHPS; ACS; and BRFSS. Independently perform a broad range of quantitative analysis to inform the design, implementation, and evaluation of Medicare and Medicaid demonstration waivers.
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The Provider Enrollment Representative will facilitate activities from the point of the provider candidate's acceptance of employment to the point of the candidate's approved enrollment with DC, Maryland, Virginia and West Virginia Medicaid and Medicare.
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Medicare knowledge required with minimum of one year of Medicare sales and one Annual Enrollment Period preferred. As a Medicare Sales Agent (internally titled Advocate Agent) you'll enjoy unlimited earning potential, the convenience to work from home, access to best-in-class paid training, and potentially the opportunity to move into a leadership role.
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As an Advocate Agent I, you'll serve as a trusted expert on all things Medicare insurance-related and have access to the nation's best carriers (Humana, Anthem, UnitedHealthcare & more!) Quickly grasp new concepts and product offerings, such as Major Medical, Medicare Advantage, Medicare Supplement, Prescription Drug Plans, and other ancillary health products.
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The Provider Enrollment Representative is a critical member of the Revenue Cycle and CNH organization teams for ensuring that providers are enrolled and prepared to begin working by the time of Board approval.
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Functions as a team member to work closely with the Provider Enrollment Relations Manager to ensure seamless coordination of activities. Generates monthly Echo audit reports for Medicare sanctions and opt-out cases.
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HealthXL contracts with physician practices to provide CCM/RPM services to their Medicare patients. A successful ES will exhibit excellent verbal communication skills, an eagerness to achieve enrollment objectives and a strong understanding of the CCM/RPM programs and their benefits for patients.
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Manage the annual Medicare/D-SNP plan benefit package design and application(s) process. Serve as an internal subject matter expert (SME) and ensure readiness of D-SNP operational functions and performance (e.g., Marketing, Sales, Enrollment, Risk Adjustment, STARs.
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Knowledge of CMS claims data, including Medicare, Medicaid, and Marketplace, in the IDR or CCW environment with Fee-for-Service (FFS), Medicare Advantage encounter data, Medicaid data in the Transformed Medicaid Statistical Information System (T-MSIS), or Prescription Drug Event (PDE) data.
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The representative will work in concert with Medical Staff Services, the individual providers, department administrators and leadership to complete the enrollment applications and submit with all related credentials, licensing and other payer specific requirements.
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We are a dedicated team focused on creating the Centers for Medicare & Medicaid Services (CMS) Blue Button 2.0 platform, an extensive Medicare data warehouse to serve Medicare beneficiaries' demographic, enrollment, and claims data in a Fast Healthcare Interoperability Resources (FHIR) format.
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Your Impact We are a dedicated team focused on creating the Centers for Medicare & Medicaid Services (CMS) Blue Button 2.0 platform, an extensive Medicare data warehouse to serve Medicare beneficiaries' demographic, enrollment, and claims data in a Fast Healthcare Interoperability Resources (FHIR) format.
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