Health Insurance Navigator

Job Title:

Health Insurance (Medicare/Medicaid)

Representative Location:

Cumberland, RI 02864

Hours:

Mon - Fri 7:30am - 4pm

Pay Rate :

$24.00/HR to $25.00/HR.

Position Summary:

The Coordinator III will work directly with other coordinators to ensure quality of work delivered, performance/productivity benchmarks are met, and all compliance related issues are properly addressed, trained and coached on a consistent basis. The Enrollment Coordinators play a critical role in working with our new member clients to determine eligibility and perform various enrollment activities. Enrollment Coordinators interface with both individual plan members and employer group and requires a strong focus around accurate and timely customer support to ensure client enrollment and retention. The Enrollment Coordinator III reports directly to the Enrollment Supervisor, also functioning as SME (Subject Matter Expert) in the functions, processes, and eligibility procedures as they relate to Medicare Part D enrollment and CMS (Center for Medicare/Medicaid Services) Standards.

Job Duties:

Submits, maintains, and monitors applications for Initial enrollment and Revalidation with Government Medicaid Payer and Commercial Payers for Clinics and Providers in order to ensure active participation Provides assistance in developing and improving payer workflow while ensuring compliance with the company's regulatory, safety, quality, and confidentiality protocols and standards. Responsible for ensuring the timely and accurate submission of Group and Provider enrollment applications for Medicaid and Commercial programs, supporting compliance and operational efficiency across payer relations. Responsible for minimizing the deactivation of government program applications by adhering to established quality control procedures. Serves as a key point of contact for escalated claim issues received from internal departments, coordinating with payers to identify and implement solutions. Communicates resolutions and relevant updates to appropriate internal stakeholders to ensure alignment and continuity.

Experience:

At least 1 year of overall related experience of Center for Medicare/Medicaid Services (CMS) guidelines for Medicare Part D enrollment processes or previous work experience in regulatory environment. Comfortable in both team player and team roles. Dependable/Responsible/Accountable Excellent spoken and written communication skills Capable of managing through transition, while fostering a positive team environment Confident in decision making ability within strict timelines Exceptional prioritization and organizational skills Acts with integrity and uses sound judgment in dealing with confidential information

Education:

High school diploma or GED required, Bachelors Degree in Business Administration, Marketing, Finance or similar field preferred and have 2+ years of relevant work experience.

Job Types:

Full-time, Contract Pay:

$24.00 - $25.00 per hour Expected hours: 40 per week

Benefits:

Health insurance

Experience:

Medicare:

1 year (Required) Insurance verification: 1 year (Required)

HIPAA:

1 year (Required) Ability to

Commute:

Cumberland, RI 02864 (Required)

Work Location:

In person