Medicare Advantage Enrollment Specialist II Remote

At Blue Cross and Blue Shield of Nebraska, we are a mission-driven organization dedicated to championing the health and well-being of our members and the communities we serve.

Our team is the power behind that promise. And, as the industry rapidly evolves and we seek ways to optimize business processes and customer experiences, thereâ??s no greater time for forward-thinking professionals like you to join us in delivering on it!

As a member of Team Blue, youâ??ll find purpose, opportunities and the support you need to build a meaningful career and make a powerful impact in our community.

This role is responsible for the accurate and timely processing of Medicare Advantage enrollment transactions utilizing CMS guidance and Blue Cross Blue Shield of Nebraska policies and procedures. The role is responsible for ensuring accurate enrollment including billing and maintenance of member data by researching and resolving enrollment and billing discrepancies. The role is also responsible for reconciling and correcting enrollment-related issues by building case files sent to CMS for approval and resolution.

As a member of Team Blue, youâ??ll find purpose, opportunities and the support you need to build a meaningful career and make a powerful impact in our community. BCBSNE is happy to offer four work designations for our Omaha area employees: 100% in-office, Hybrid options, and 100% remote. If choosing to work remote, this role can be located in one of the following states: Florida, Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, and Texas.

What you'll do:

• Develop knowledge of CMS Manual Chapter 2 and Part D Manual Chapter 3, Eligibility, Enrollment and Disenrollment, terminology, and concepts of election periods, enrollment, and disenrollment.
• Ensure the accuracy and timeliness of processing enrollments and disenrollment in compliance within CMS regulations and BCBSNE policies and procedures.
• TRR Processing knowledge.
• Research and resolve enrollment audit findings and identify potential gaps, make recommendations to implement process improvements.
• Provide peer skills enhancement training to address any gaps in process and/or technology.
• Assure billing processes, delinquency, refunds, and other financial updates are completed to member profiles to accurately reflect expected results.
• Responsible for determining accurate results for transaction reply codes based on CMS guidance; accountable for resolving and closing pended enrollment records in the core administrative system.
• Adhere to productivity, quality, and compliance expectations.
• Research, resolve and submit CMS required enrollment audits and case reviews.
• Collaborate with other team members on special projects as assigned by the Manager, including process documentation, training, and quality audits.
• Conduct maintenance and resolution for daily systems reconciliation and discrepancy reports.

To be considered for this position, you must have:

• Associate's degree in a related field or equivalent experience.
• 3 years of professional experience in processing Medicare Enrollment transactions.
• Minimum 1 year experience in the health care industry.
• Excellent verbal and written communication skills.
• A strong work ethic with the ability to multi-task is essential.
• Ability to work independently, prioritize and work under deadlines. Attention to detail.
• Knowledge and experience using Excel, Microsoft Word, and ten-key efficiency; ability to quickly adapt to new systems.
• The ability to adapt quickly to a fast-paced environment, self-starter, and quick learner.
• Interpersonal skills to work well within a team that includes all levels within the organization from clerical and support staff to senior management as well as members and brokers outside of the organization.
• Ability to analyze enrollment reconciliation data, complex case files, and audit findings for resolution.
• Report SLAs, KPIs, and other operations reports and present findings in a structured format. â??

An equivalent combination of education and experience may be substituted for this requirement. The ability to meet or exceed the attendance and timeliness requirements of their departments.

The ability to work well in a team environment and be capable of building and maintaining positive relationships with other staff, departments, and customers.

To perform this job successfully, an individual 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. Other duties may be assigned.

Learn more about what makes BCBSNE such an exceptional place to work by visiting NebraskaBlue.com/Careers.

We strongly believe that diversity of experience, perspective and background will lead to a better workplace for our employees and a better product for our customers and members.

Blue Cross and Blue Shield of Nebraska is an Equal Opportunity /Affirmative Action Employer - Minorities/Females/Disabled/Veterans