Job Description

LE0016 MMMFL Holdings, LLC

It's fun to work in a company where people truly BELIEVE in what they're doing!

We're committed to bringing passion and customer focus to the business.

We currently have an opening for an Enrollment Specialist. This position will be responsible to work with the daily operational processes of the Enrollment Department, as well as maintain compliance with CMS and Company’s policies and procedures.

Duties and Responsibilities:

• Analyze and validate the needed steps of eligibility process of the Enrollment application
• Process enrollment applications, disenrollment request, PBP Changes and Cancellation request
• Work with Sales Application and understand the different workflows and queues.
• Work with Customer Service Application Programs including the Pharmacy applications on a daily basis
• Ensure that all eligibility and demographic changes received from the beneficiary are process in an accuracy and timely matter
• Ensure privacy and confidentiality of the protected health information (PHI) and corporate information accessible as part of the position’s functions
• Coordinate sales and customer service incident process and inquiries response.
• Analyze, provide input, feedback and guidance on the resolution of member enrollment inquiries and service requests
• On a daily basis revise that all complete, incomplete and denial letters area process as required
• Comply with the monthly close process, including any reporting requirements.
• Provide feedback to the Enrollment Manager of any process that can be modify or improved in the daily process
• Ensure to meet a minimum of a 90% of the individual metric result
• Ensure the privacy and confidentiality of the protected health information (PHI) and corporate information accessible as part of the position’s functions.
• Comply with CMS policies, Medicaid Agency Policies, MOC requirements, Procedures and CMS guidelines for Enrollment and Operational Processes for MA-PD products including internal Policies and Procedures
• Participate in all departmental training sections and keep up to date changes in CMS guidelines and regulations.
• Attend to all trainings per guidelines of the MOC related to functions of enrollment and customer service
• Notify Manager of any processes not in compliance with the Plans' policies and MOC requirements, which includes SNP, and MA-PD.
• Assist Manager or Participate in any special project assigned by the Enrollment Management.

Skills and Qualifications:

• 2+ years of related experience in the area of Enrolment
• Understanding in the process flow for the enrollment and PBP applications.
• Understanding in the process flow for incomplete applications.
• Understanding in the process flow for the disenrollment and cancellation requests
• Understanding in the process flow for the enrollment files and basic file setup.
• Time Management Skills: establishing priorities and accomplishing tasks in a timely manner
• Ability to operate On Base System and its workflow queues
• Experience with Office, Word, Excel, Power Point and Outlook
• Skills in establishing and maintaining effective working relationships with employees, policy-making bodies
• Self-directed with good organizational skills
• Skill in organizing work, making assignments and achieving goals and objectives

MMM of Florida is an equal opportunity employer. We are committed to providing a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the organization. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives.

As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. We are dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.

If you like wild growth and working with happy, enthusiastic over-achievers, you'll enjoy your career with us!

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