Enrollment Specialist

TEMPORARY POSITION FOR PROJECT - NO OPTIONS FOR PERM OR EXTENSION

WORK LOCATION : Fully On-site

SHIFT : Monday - Friday 8am - 5pm

REQUIRED EXPERIENCE :

• HS Diploma or equivalent Required
• Intermediate level of Microsoft work or Excel required
• 1 year experience in office setting with basic administrative skills including Microsoft Word and Excel Required
• Excellent oral and written communication skills Required

PREFERRED EXPERIENCE :

POSITION TITLE : Membership Support Processor - SHP

JOB SUMMARY

The SHP Membership Support Processor is responsible for processing eligibility additions,

modifications and terminations. This includes resolving all billing and accounts receivable issues. Also

responsible for applying Centers for Medicare and Medicaid Services (CMS) regulations and policies to

each Advocare enrollment and disenrollment request. Provide additional support as needed for all

enrollment functions.

ESSENTIAL JOB FUNCTIONS

1. Reviews all incoming member and employer group materials. Determines and records appropriate

identification number. Verifies and / or updates demographic information as appropriate.

2. Determines enrollment periods, pre-existing condition expiration dates and creditable coverage.

Processes eligibility additions, modifications and terminations. Establishes appropriate billing

method.

3. Works with member, employer group, agent and CMS to resolve any outstanding questions.

4. Reviews and approves enrollment reports prior to weekly transmission of eligibility files to CMS.

5. Analyzes and resolves billing and accounts receivable issues for members regarding premium

payments and delinquent accounts. Posts member premium payments. Audits and monitors

monthly premium billings and collects on all delinquent accounts.

6. Documents all verbal and written contacts.

7. Regular attendance is required in order to carry out the essential functions of the position.

8. Reviews and meets ongoing competency requirements of the role to maintain the skills, knowledge

and abilities to perform, within scope, role specific functions.

ADDITIONAL DUTIES

1. Other duties as assigned.

JOB QUALIFICATIONS

EDUCATION

For positions requiring education beyond a high school diploma or equivalent, educational qualifications must be

from an institution whose accreditation is recognized by the Council for Higher Education and Accreditation.

Minimum Required : Intermediate level of Microsoft Word and Excel classes required, or must

demonstrate equivalent expertise.

Preferred / Optional : Additional college or technical school classes in business or insurance.

EXPERIENCE

Minimum Required : Minimum of one year experience in office setting with basic administrative

skills, including data entry, Microsoft Word and Microsoft Excel. Excellent oral and written

communication skills.

Preferred / Optional : One to two years experience in insurance processes or finance.

PATIENT POPULATIONS SERVED

Individuals hired are expected to serve patients of different ages, backgrounds, etc. When performing

the essential functions of the role, the individual must identify the patient age group to be served and

apply the appropriate care based on the patient s age and background. The hiring manager is

responsible for communicating the patient population generally encountered in the role and is

responsible for ensuring the appropriate cultural, age and related training needed to serve the patient

populations.