Enrollment Project Coordinator
Location: Orange, California US
Job Number: 2236
Position Title: Enrollment Project Coordinator
Enrollment Project Coordinator
The Membership Project Coordinator (MPC) shall support various functions of the Membership Unit. This includes ensuring that the staff has the necessary resources to perform their day to day activities. Coordinates and implements CMS communication projects with responsibilities that include Late Enrollment Penalty (LEP), Best Available Evidence (BAE) and Part D guidance. Organizes the preparation of assigned projects and provides the Membership Unit Director with strategic methods to implement such tasks or projects. Work under general supervision.
Essential Duties and Responsibilities
Essential duties and responsibilities include, but are not limited to:
- Interpret and complete all guidelines as related to BAE, LEP and Part D requirements as they pertain to the Membership Unit.
- Collaborate with the PBM on the monthly LIS reimbursement’s and recoupment’s (negative balance) to ensure proper payment to the member and plan.
- Revise or create any Policy & Procedure that pertains to applicable assignments.
- Responsible for the monthly uploaded and downloads to Acumen. (LIS & BAE)
- Ensure LEP processes are in place and well as working the monthly, weekly and daily reports.
- Maintains files and members correspondence for a monthly internal audit purpose.
- Collaborate with I.T. on all CMS updates.
- Assist in preparation of all department mailings.
- Assist with enrollment process when needed.
- Ensure that all systems are in place when there are CMS software updates or changes
- Assist Membership Director with any special project or task as assigned.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below 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.
- Education and/or Experience: High school diploma or general education degree (GED);
- Certificates, Licenses, Registrations: None required. Other Qualifications:
- Basic knowledge of Medi-Cal and Medicare Advantage Prescription Drug Plans.
- 3 to 4 years direct customer service experience.
- Direct sales or related experience preferably in the Managed Care industry.
- Basic Computer Skills, 40 WPM (Microsoft Outlook, excel, word)
- 10-Key by Touch
- Direct handling and processing of CMS enrollments and disenrollment applications.
- Bilingual (English/Spanish) is required.
- Must be familiar with CMS MMR and TRR files
Skills and Abilities
- Language Skills: Ability to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals. Ability to write routine reports and correspondence.
- Mathematical Skills: Ability to add and subtract two digit numbers and to multiply and divide with 10’s and 100’s. Ability to perform these operations using units of American money and weight measurement, volume, and distance.
- Reasoning Skills: Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions.
- Excellent communication skills, oral and written.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear.
- The employee is frequently required to walk; stand; reach with hands and arms.
- The employee is occasionally required to climb or balance and stoop, kneel, crouch, or crawl.
- The employee must occasionally lift and/or move up to 25 pounds.
- Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Location City: Orange
Location State: California
Community / Marketing Title: Enrollment Project Coordinator
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