Job Description

Job Location: Any Location Remote US - Oklahoma City, OK 73102
Position Type: Full TimeEducation
Level: High School or Equivalent
Travel Percentage: None
Job Shift: Day
Job Category: Admin - ClericalWHO WE ARE:
GlobalHealth is a fast-growing Medicare Advantage HMO health insurer. We aspire to be the employer of choice in our industry, attracting and retaining a highly talented workforce. Our passion is Genuine Care and Optimal Health for the members we serve. We are unique by providing high touch, high value and a partnership to our members. We go above and beyond to provide personalized, engaging, and responsive services to our members. We work hard to offer affordable health insurance coverage with the benefits people truly want and need. It is our hope to be more than just a health insurance company we want to be long-term partners with our members. We are looking for future employees who exude our core values of taking accountability through ownership, being driven, innovative and who have a passion for continuous learning.
WHO YOU ARE:
The successful candidate will utilize and further develop their existing expertise in Medicare Advantage enrollment processes and guidelines.  This candidate will perform advanced functions of enrollment and eligibility to provide exceptional service to members and cross-functional teams. This candidate will have expert knowledge of enrollment activities and a full understanding of Chapter 2 of the Medicare Managed Care Manual. This candidate will know how to resolve enrollment system rejections and develop retroactive cases and assist in providing guidance to other team members in best practice resolutions. This job exists to ensure that there is proper coverage in the department regardless of the workflow that is needing processed.  This position is expected to support and participate in regulatory audits.

QualificationsESSENTIAL JOB FUNCTIONS:
- Review enrollment requests and other documents of Medicare beneficiaries that are applying or Medicare Advantage products using knowledge and expertise of program standards and government rules and regulations. Makes decisions regarding members eligibility to enroll.
- Perform all functions of verification for SNP enrollees and members to ensure proper validation and provider attestations are completed.
- Processes Transaction Reply Reports (TRR), completing any action directed by CMS and follows through via documentation in system and mailing of notifications to members.
- Investigates, resolves, and reports problems to appropriate management or staff through customer service ticketing or other electronic methods.
- Responsible for performing premium billing functions and reconciliation according to CMS guidelines and internal procedures.
- Performs other duties as assigned.
EDUCATION AND EXPERIENCE:
- High school diploma or equivalent
- Bachelors degree preferred
- 5+ years experience in a Medicare Advantage health plan is required
- 5+ years experience in Enrollment processes for a Medicare Advantage health plan is strongly desired
- 5+ years experience in TRR processing and clearing CMS rejections is preferred
- 2+ years experience in Medicare Advantage SNP verification is preferred
KNOWLEDGE, SKILLS AND ABILITIES:
- Strong attention to detail and good organization and time management skills, including ability to multi-task, learn new skills and reach set goals.
- Knowledge of Microsoft software programs including Word, Excel, and PowerPoint.
- Must be able to communicate, both orally and in writing, clearly and effectively
- Proven ability to work independently or as a member of a team
- Knowledge of Medicare Managed Care Plans required
- Microsoft Office proficient, including the ability to save and send documents, spreadsheets, and emails, other forms of documentation

WORK ENVIRONMENT:
- This position works in a climate-controlled office setting.
- May be subjected to a fast-paced decision-making environment.
TRAVEL:
- This position is not required to travel.
SUPERVISORY RESPONSIBILITY:
- This position does not have any supervisory responsibilities.
OTHER DUTIES:
This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may