Enrollment Quality Specialist Position Available In Hernando, Florida

Enrollment Quality Specialist Mirra Health Care /CSTS Customer Service and Technology Solutions LLC Spring Hill, FL 34609

• Hybrid work Company Overview Mirra Health Care & CSTS Customer Service and Technology Solutions LLC are leading third-party administrator specializing in the operational and administrative management of insurance plans.

Our mission is to enhance the healthcare experience by delivering exceptional products and services to our partners. Summary We are seeking an Enrollment Quality Specialist to join our dynamic team at Mirra Health Care. The Enrollment Quality Specialist is responsible for auditing all enrollment transactions submitted to CMS. This position is also responsible for auditing CMS monthly reports and reconciling the daily TRR (DTRR) and conducts monthly Medicaid recertification for the Dual-Eligible members. This position works closely with the Enrollment Manager to ensure all applications and transactions reply codes are accredited in accordance with CMS guidelines. Essential Duties and Responsibilities 1. Audit and research all applications, disenrollments and transactions for completeness using all CMS regulations and time frames. Identifies all incomplete and complete enrollment elections in compliance with CMS regulations. 2. Audit and reconciles documents and attachments in Enrollment Receiving log and reports discrepancies to Enrollment Manager. 3. Audit daily letters and submit batching and approval to print the notices. 4. Prepares written responses using Federal and State Regulation guidelines and time frames. 5. Performs audits of all prospective members for HMO, CSNP, and DSNP Medicaid eligibility as needed. 6. Reconciles eligibility discrepancies, analyzes transactional data and submits retroactive eligibility changes. Ensures completeness and timely processing of category 2 cases (Reed & Associates). 7. Audit, monitor and process Medicaid recertification for current DSNP enrollees. 8. Responds to member eligibility or group questions and verifies enrollment status. 9. Audits daily

TRR, CMS

rejections, LEP, Premium Billing and Payment, and EDV retro transactions to ensure appropriate reconciliation of the MMR. 10. Provides coaching to team members based on audit results and maintains monthly meeting updates with management on employee improvements. 11. Update demographic data, benefits and other fields in the Enrollment systems based on reports or other documents received and assigned by Leadership. 12. Audit the multi-county report and provide outcome to management. Other Duties Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities that are required of the employee for this job. Other duties may apply as assigned by the applicable Manager. Required Education and Experience 1. High school diploma or equivalent plus four to seven years’ previous experience. 2. Previous experience in a Medicare Advantage Plan. 3. Experience working CMS monthly reconciliation reports is required. 4. Expert in Microsoft Office applications. 5. Experience in CMS systems. Competencies To perform the job successfully, an individual should demonstrate the following competencies: 1. Analytical

• Synthesizes complex or diverse information; Collects and researches data; Uses intuition and experience to complement data; Designs workflows and procedures. 2. Design
• Demonstrates attention to detail. 3. Technical Skills
• Assesses own strengths and weaknesses; Pursues training and development opportunities; Strives to continuously build knowledge and skills; Shares expertise with others. 4. Customer Service
• Manages difficult or emotional customer situations; Responds promptly to customer needs; Meets commitments. 5. Interpersonal Skills
• Focuses on solving conflict, not blaming; Maintains confidentiality; Listens to others without interrupting; Keeps emotions under control; Remains open to others’ ideas and tries new things. 6. Problem Solving
• Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem solving situations; Uses reason even when dealing with emotional topics. 7. Oral Communication
• Speaks clearly and persuasively in positive or negative situations; Listens and gets clarification; Responds well to questions; Demonstrates group presentation skills; Participates in meetings. 8. Written Communication
• Writes clearly and informatively; Edits work for spelling and grammar; Varies writing style to meet needs; Presents numerical data effectively; Able to read and interpret written information. 9. Teamwork
• Balances team and individual responsibilities; Exhibits objectivity and openness to others’ views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; Able to build morale and group commitments to goals and objectives; Supports everyone’s efforts to succeed. 10. Visionary Leadership
• Displays passion and optimism; Inspires respect and trust; Mobilizes others to fulfill the vision; Provides vision and inspiration to peers and subordinates. 11. Delegation
• Delegates work assignments; Matches the responsibility to the person; Gives authority to work independently; Sets expectations and monitors delegated activities; Provides recognition for results. 12. Quality Management
• Looks for ways to improve and promote quality; Demonstrates accuracy and thoroughness. 13. Diversity
• Shows respect and sensitivity for cultural differences; Promotes a harassment-free environment; Builds a diverse workforce. 14. Ethics
• Treats people with respect; Keeps commitments; Inspires the trust of others; Works with integrity and ethically; Upholds organizational values. 15. Organizational Support
• Follows policies and procedures; Supports organization’s goals and values; Supports affirmative action and respects diversity. 16. Judgment
• Exhibits sound and accurate judgment; Supports and explains reasoning for decisions; Includes appropriate people in decision-making process; Makes timely decisions. 17. Motivation
• Sets and achieves challenging goals; Demonstrates persistence and overcomes obstacles; Measures self against standard of excellence. 18. Planning/Organizing
• Prioritizes and plans work activities; Uses time efficiently; Plans for additional resources; Sets goals and objectives; Organizes or schedules other people and their tasks; Develops realistic action plans. 19. Professionalism
• Approaches others in a tactful manner; Reacts well under pressure; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions; Follows through on commitments. 20. Quality
• Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality; Applies feedback to improve performance; Monitors own work to ensure quality. 21. Quantity
• Meets productivity standards; Completes work in timely manner; Strives to increase productivity; Works quickly. 22. Safety and Security
• Observes safety and security procedures; Reports potentially unsafe conditions ; Uses equipment and materials properly. 23. Adaptability
• Adapts to changes in the work environment; Manages competing demands; Changes approach or method to best fit the situation; Able to deal with frequent change, delays, or unexpected events. 24. Attendance/Punctuality
• Is consistently at work and on time; Ensures work responsibilities are covered when absent; Arrives at meetings and appointments on time. 25. Dependability
• Follows instructions, responds to management direction; Takes responsibility for own actions; Keeps commitments; Commits to long hours of work when necessary to reach goals.; Completes tasks on time or notifies appropriate person with an alternate plan. 26. Initiative
• Seeks increased responsibilities; Asks for and offers help when needed. 27. Innovation
• Meets challenges with resourcefulness; Generates suggestions for improving work.

If you’re ready to make a difference in the healthcare landscape and help others navigate their insurance options, we invite you to apply for the Enrollment Specialist position at Mirra today!

Job Type:

Full-time Pay:

$20.00

• $25.

00 per hour Expected hours: 40 per week

Benefits:

401(k) 401(k) matching Dental insurance Employee assistance program Health insurance Life insurance Paid time off Vision insurance

Schedule:

8 hour shift Monday to

Friday Work Location:

Hybrid remote in Spring Hill, FL 34609