Candidates should have Medicare knowledge, Reconciliation of TRR and MMR Process
Summary
This position is responsible for ensuring that Medicare Advantage membership enrollment is in sync by reconciling CMS enrollment records and Client enrollment records via review of Daily Transaction Reply Reports (DTRR) and the Monthly Membership Reports (MMR) while abiding by Federal Centers for Medicare and Medicaid Services guidance.
Duties
- Reconciliation of all daily, weekly and monthly Medicare reports generated from CMS.
- Research and resolve enrollment discrepancies identified as a result of company and MMR reports and Client records.
- Directly respond or support a response to inquiries that is rapid and professional to internal and external customers, not limited to Medicare Beneficiaries, Federal Regulators, Executives and Congress persons.
- Generating and ensuring compliance and accuracy of various types of member correspondence specific to retroactive enrollment submission to CMS.
- Identification and communication of processing performance opportunities.
- Responsible for updating beneficiary requests for enrollment for premium withholding.
- Ensure that on a monthly basis all identified discrepancies resolutions are met with CMS timeframes.
- Prepare case documents for retroactive enrollment updates
- Performs other duties as assigned by management.
Core Individual Contributor Competencies :
- Personal and professional attributes that are critical to successful performance for Individual Contributors :
- Customer Focus
- Accountable
- Learn
- Communicate
Qualifications
- High School diploma or GED required, Bachelor's degree from an accredited college or university preferred.
- Minimum of 5 years health insurance industry or related Medicare experience
- Excellent oral and written communication skills.
- Strong analytical and problem solving skills.
- Proficiency in analysis techniques and Access database
- Knowledge of system development life cycle and implementation methodologies preferred.
- Prefer ability to translate CMS regulatory guidance.
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