Location: San Diego, CA Remote Location: # of openings: 1 Department: Employment duration: Full time Exemption Status: Non-Exempt Relocation Assistance: N/A Added to system: 1/20/23 9:49 AM Job Code: 990.012023.8032

Description

Medicare Enrollment Specialist I/II

$44,462 - $57,800 - $71,138

Pay scale information is not necessarily reflective of actual compensation that may be earned, nor a promise of any specific pay for any selected candidate or employee, which is always dependent on actual experience, education, qualifications, and other factors. A full review of our comprehensive pay and benefits will be discussed at the offer stage with the selected candidate.

MedImpact Healthcare Systems, Inc. is looking for extraordinary people to join our team!

Why join MedImpact? Because our success is dependent on you; innovative professionals with top notch skills who thrive on opportunity, high performance, and teamwork. We look for individuals who want to work on a team that cares about making a difference in the value of healthcare.

At MedImpact, we deliver leading edge pharmaceutical and technology related solutions that dramatically improve the value of health care. We provide superior outcomes to those we serve through innovative products, systems, and services that provide transparency and promote choice in decision making. Our vision is to set the standard in providing solutions that optimize satisfaction, service, cost, and quality in the healthcare industry. We are the premier Pharmacy Benefits Management solution!

The Scoop:

The Medicare Enrollment Specialist I/II acts as the MedGenerations liaison between Part D Sponsors and our Employer Groups/TPA's. The Specialist is well versed in all Part D related guidance as published by the Centers for Medicare and Medicaid Services (CMS) with extensive focus on eligibility & enrollment and Grievance/Complaint Tracking Module (CTM) management. The role requires self-motivation, organization and is given a wide degree of latitude to perform the function.

What You Get To Do: Include the following, other duties may be assigned

· Processes a variety of membership enrollment changes that require special handling while taking ownership and accountability through problem resolution

· Maintains an understanding of the electronic enrollment data flow processes between our employer groups, Plan Management Tool (PMT), TMG Enrollment System, CMS, and MedAccess in order to complete complex transactions that may involve multiple systems, such as those needed to effect retroactive enrollment corrections through the retroactive processor (RPC)

· Reviews electronic files to identify and resolve simple system-related data flow discrepancies

· Investigates transactions that did not go through the processing system by completing research within all available systems and/or consulting with the client and correcting errors within expected standards of performance for compliance and production

· Assists with preventive maintenance by analyzing, identifying and logging potential processing issues and root problems, then synthesizing relevant data to recommend viable solutions and workarounds

· Responds to client emails, phone calls, Complaint’s (via the Complaints Tracking Module (CTM), and Salesforce cases in a timely fashion

· Establishes excellent working relationships with the Part D Sponsor, CMS, and related client base

· Acts as integral part of the client team and attends all related client calls

· Reviews correspondence, returned mail and requests for investigation and/or action from beneficiaries and other departments, investigates, responds to issues and takes actions accordingly, or routes to proper area for completion

· Maintains proper documentation for historical reference and audit purposes

· Researches issues related to enrollment, billing and claims processing

· Executes SQL queries, extracting data from relational data bases and tables for purposes of audit and reporting support

· Gains and maintains good familiarity with the plan designs and benefit setups for each client

· Assists with claims testing process

· Works closely with the client teams and the implementation teams in reviewing the test claim results

· Provides client-facing support for Project Implementation and/or internal implementation support including Sales/Account Management support for Business Development

· Communicates all enrollment specific CMS guidance changes to assigned clients/client teams

· Compiles and provides daily, weekly and monthly enrollment and monitoring related reports both internally and externally

· Takes inbound calls and places outbound calls to members to assist with eligibility and enrollment inquiries or issues, member collections, CTM’s, Grievances, COB (Coordination of Benefits) notification and other member communications

· May be required to deviate from standard scripts and apply knowledge of CMS rules in order to address member inquiries or concerns. On-call alternating weekends for CTM/Grievance monitoring

· Writes policies and procedures or necessary Work Instructions for each area of responsibility

Level II duties include all of the above in addition:

· Makes the decision on how to handle complex enrollment changes and enrollment related appeals by using data and advance record processing

· Troubleshoots, determines root cause, and resolves client inquiries for assigned clients

· Leads and acts as the liaison to coordinate the annual claims testing process for all clients working with the client teams, Benefits, the QC team, PDP IT and internal staff to ensure all testing is complete and coding is accurate and compliant

· Triages and analyzes trends to identify record level improvement opportunities either internally or externally, defines business requirements by working with the PDP IT team and follows resolution through to deployment of applicable system enhancements

· Manages, drives and tracks resolution for enrollment related projects and issues and fosters collaboration from both the business and technology groups

· Manages all enrollment related metrics reporting and conducts advanced file monitoring to ensure all systems are in sync

· Trains and mentors less experienced employees within the department

Education and/or Experience

Level I

For consideration candidates will need an Associates degree preferred (or equivalent combination of education and experience) with 3 – 5+ years related experience. Prior experience in the PBM, pharmaceutical, or healthcare or health & welfare insurance industry required.

Level II

For consideration candidates will need a Bachelor’s degree required (or equivalent combination of education and experience) with 5+ years’ related experience. Prior experience in the PBM, pharmaceutical, or healthcare or health & welfare insurance industry required. Pharmacy Technician or license, not required, but very helpful.

Computer Skills

To perform this job successfully, an individual should have intermediate knowledge of MS Office Suite (Word, Excel, PowerPoint), Outlook or other email system and databases. Working knowledge of running established SQL queries and familiarity with the use of databases.

Other Skills and Abilities

· Detail oriented with a high degree of accuracy and follow through.

· Self-starter with the ability to work independently and as part of a team.

· Ability to manage multiple projects simultaneously and prioritize competing demands.

· Well-versed in all Part D related guidance as published by the Centers for Medicare and Medicaid Services (CMS) with extensive focus on eligibility & enrollment and Grievance/Complaint Tracking Module (CTM) management with the ability to assimilate and keep up to date with changes.

· Must have the ability to learn and use MedImpact proprietary and vendor systems to research and solve enrollment, billing or claims processing concerns.

Level II, additionally, will have the following skills and abilities:

· Negotiations skills and the ability to navigate escated issues to reach successful and sometimes complex outcomes.

· Possesses a cross-functional understanding of GPS processes within different departments required.

Travel

This position may require occasional travel and/or attendance may be required at various local conferences, meetings and client benefit fairs.

The Perks:

· Medical / Dental / Vision / Wellness Programs

· Paid Time Off / Company Paid Holidays

· 401K with Company match

· Life and Disability Insurance

· Tuition Reimbursement

· Employee Referral Bonus

This position is eligible for Employee Referral Bonus at Level I

To explore all that MedImpact has to offer, and the greatness you can bring to our teams, please submit your resume to www.medimpact.com/careers

MedImpact, is a privately-held pharmacy benefit manager (PBM) headquartered in San Diego, California. Our solutions and services positively influence healthcare outcomes and expenditures, improving the position of our clients in the market. MedImpact offers high-value solutions to payers, providers and consumers of healthcare in the U.S. and foreign markets.

Equal Opportunity Employer, Male/Female/Disabilities/Veterans

OSHA/ADA:

To perform this job successfully, the successful candidate must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Disclaimer:

The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.