Enrollment QA Analyst

Job Description:

POSITION SUMMARY
THE ENROLLMENT QA ANALYST IS RESPONSIBLE FOR CONDUCTING THE NECESSARY RESEARCH AND COORDINATION TO ENSURE THAT ALL ENROLLMENTS, DISENROLLMENTS, PLAN CHANGES AND RECONCILIATION ACTIVITIES ARE DOCUMENTED ACCURATELY AND PROCESSED ACCORIDNG TO CMS GUIDELINES.

GENERAL RESPONSIBILITIES

  • MAINTAIN WORKFLOWS FOR HANDLING ENROLLMENT OPERATIONS AND MEMBERSHIP RECONCILIATION ACTIVITIES.
  • PERFORM AND MAINTIAN ENROLLMENT AND MEMBERSHIP RECONCILIATION QUALITY PROGRAM IN OMT
  • ASSIST MANAGER IN PREPARATION OF REPORTS AND RESPONSES TO REGULATORY AUDITS
  • CONDUCT REGULAR AUDIT OF ENROLLMENT ACTIVITIES AND PROVIDE REPORTING TO MANAGER AND POST ON OMT
  • ANALYZE ENROLLMENT AND MEMBERSHIP RECONCILIATION ACTIVITIES TO IDENTIFY ANY NECESSARY REFINEMENT OF BUSINESS RULES AND WORKFLOWS IN ORDER TO IMPROVE THE OVERALL PROCESS.
  • CONTRIBUTE TO THE DEVELOPMENT AND MAINTENANCE OF DESKTOP PROCEDURES.
  • CONTRIBUTE TO THE DEVELOPMENT OF ENROLLMENT REPORTS.
  • ASSIST IN DEVELOPMENT OF TRAINING MATERIALS AND TRAINING AS REQUIRED
  • DEVELOP TRACKING MECHANISMS AND MONITOR DUE DATES FOR ALL REQUIRED ACTIVITIES
  • PERFORM OTHER TASKS AS ASISGNED BY THE DIRECTOR OF OPERATIONS

    REQUIRED EDUCATION AND EXPERIENCE
  • BACHELOR DEGREE PREFERRED.
  • MINIMUM OF 4 YEARS ENROLLMENT AND/OR STRONG QA EXPERIENCE REQUIRED

    REQUIRED KNOWLEDGE, SKILLS, AND ABILITIES
  • STRONG KNOWLEDGE OF CMS/MEDICARE ADVANTAGE REGULATIONS.
  • STRONG COMPUTER SKILLS INCLUDING MS OFFICE AND SPECIFICALLY MS EXCEL.
  • FAMILIARITY WITH THE FACETS AND EAM MANAGED CARE SYSTEM IS A PLUS.
  • DOCUMENTED HISTORY OF ATTENTION TO DETAIL AND ACCURACY.
  • STRONG KNOWLEDGE OF QA PROCESSES

    We are proud to be an EEO/AA employer M/F/D/V. We maintain a drug-free workplace and perform pre-employment substance abuse testing.



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