• Medicare Advantage Enrollment Representative

    UCLA Health (Los Angeles, CA)


    Description

    As a member of the Medicare Advantage Operations team, the Medicare Advantage Enrollment Representative plays a crucial role in the enrollment process by reviewing and submitting enrollment requests. This position requires meticulous attention to detail to ensure the accuracy and timeliness of acknowledgment notices sent to members. The ideal candidate will possess excellent communication skills and the ability to collaborate with various departments to address member issues promptly and implement ADHOC resolutions to sustain quality member care.

    This role is responsible for all aspects of enrollment:

    + Reviews and submits Enrollment requests received as well as maintaining accuracy and timeliness of acknowledgment notices to members

    + Maintains open lines of communication with various departments to resolve member issues and implement ADHOC resolutions to sustain quality member care

    + Uses Key Performance Indicator's (KPIs) to identify trends and risks; manage service and Operating Level Agreement metrics/reporting and present findings

    + Reviews Medicaid Aid codes and their corresponding Medicaid level and interpretation for department processes.

    + Ensures quality and compliance to meet applicable guidelines; ensure timely, accurate and complete submissions to CMS - Medicare

    + Identifies continuous improvement initiatives to streamline processes, reduce member complaints and improve the overall member experience

    + Ensures that prospective enrollees are appropriately screened to meet eligibility requirements within regulatory timelines

    + Works closely with the Sales and Compliance teams to ensure timely submissions and resolution of eligibility issues, as well as departmental goals and quality goals are met

    + Ensures the required member mailings are sent in a timely fashion

    + Other duties as assigned

     

    Salary Range: $22.85 - $32.03/Hourly

    Qualifications

    We're seeking detail-oriented, self-directed professional with:

    + High School Diploma and/or equivalent experience required

    + Experience in a Medicare or Managed Care environment, Member Enrollment and Billing experience preferred

    + Ability to analyze and organize complex federal and private insurance regulations

    + Working knowledge of Microsoft Office Suite (Excel, Word, and PowerPoint) and data visualization tools.

    + Skill in prioritizing and performing a variety of duties within a system that has frequently changing assignments, priorities and deadlines

    + Strong critical thinking and the ability to apply knowledge at a broad level is essential

    + Reliability and compliance with scheduling standards

     

    UCLA Health welcomes all individuals, without regard to race, sex, sexual orientation, gender identity, religion, national origin or disabilities, and we proudly look to each person’s unique achievements and experiences to further set us apart.