Enrollment Specialist Resume Samples

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T Daniel

Terrill

Daniel

995 Agustina Isle

New York

+1 (555) 862 5598

995 Agustina Isle

New York

Phone

p +1 (555) 862 5598

Experience Experience

Detroit, MI

Enrollment Specialist

Detroit, MI

Heidenreich, Boyer and Mohr

Detroit, MI

Enrollment Specialist

Provide feedback to management concerning possible problems or areas of improvement
Develop project plans and manage logistics for special initiatives related to marketing, recruitment, and enrollment management
Work cross-functionally with other departments to develop or review processes and to resolve member issues
Develop strong working knowledge of payor policies for multiple states
Maintain and/or make corrections to existing provider files
Initiate and assist with developments/changes to increase quality and production
Assists in development and/or maintenance of training/user/system manuals

Detroit, MI

Claims Enrollment Specialist

Detroit, MI

Upton-Connelly

Detroit, MI

Claims Enrollment Specialist

Serve as liaison between Practice Administrators, Office Managers and/or Billing Managers and insurance plans
Create customized fee schedules for Providers
Provide expertise / claims support to all stakeholders
Contribute beyond fundamental responsibilities to support company growth and department development
Knowledge of physician office operations and the effect of managed care on a physician's practice
Collaborate with Provider Relations Representatives
Responds to requests for information and telephone inquiries from Providers and insurance carriers, in a courteous manner

present

Detroit, MI

Senior Enrollment Specialist

Detroit, MI

Ullrich, Hills and Harvey

present

Detroit, MI

Senior Enrollment Specialist

present

Creating accurate and compliant enrollment materials while maintaining quality
Responsible for completion of web enrollment case set-up on the Prudential web enrollment platform, or by partnering with a third-party platform
Responsible for management of project timelines related to assigned enrollment requests, adhering to standard turnaround times and meeting all customer enrollment event deadlines
Acting as a subject matter expert representing enrollment on projects
Partnering with third party vendors and internal business partners to execute requests on time and to trouble shoot when issues may arise
Responsible for relationship management with Distribution, Marketing, Compliance, Quality, Service and Product partners
Responsible for the Creation of and updating/maintaining SOPs for all enrollment activities

Education Education

Bachelor’s Degree in Marketing

New York University

Bachelor’s Degree in Marketing

Skills Skills

Problem solving skills with the ability to look for root causes and implementable, workable solutions
Strong knowledge of Microsoft Office, specifically Excel, Word, and Outlook Exchange; proficient in Internet Explorer
Ability to communicate with various business contacts in a professional and courteous manner
Strong attention to detail
Computer skills and familiarity with research process is highly desirable
Flexible, high achiever with ability to learn quickly and meet department goals and deadlines consecutively
Ability to pay close attention to detail and to ensure accuracy of reports and data
Strong organizations, multi-tasking and attention to detail within a high volume fast paced environment is essential
Professional verbal and written communication skills, with the ability to clearly articulate thoughts and ideas
Customer service skills with the ability to interact professionally and effectively with providers, third party payers, physicians, and

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15 Enrollment Specialist resume templates

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Enrollment Specialist Resume Examples & Samples

Ensures the platform configuration / readiness that supports a client through their annual open (or other significant recurring) enrollment processes
The Specialist may be responsible for either: a) all "hands-on" configuration and related activities, &/or b) completion of these activities through others (ex. client representatives, internal service teams and partners, or ADP "supplemental" resources and off-shore, etc.) in a consultative role
This also includes all project activities involved in coordinating ADP resources as necessary and ensuring that all necessary ADP-specific tasks are accomplished on time and as required
Capable of coordinating larger / "more complex" enrollment events for clients with more sophisticated requirements and integration. In addition, this level may focus on "special" (i.e. "more needy") clients. May also be tasked with increasing involvement with carrier connections
A variety of Comp Svc mgrs / professionals assigned to a given client. (ex. HRB Service, Payroll, Connection Services, FSA, COBRA, Service Team, Relationship Mgmt, Implementation, etc.)
May coach less senior Specialists and provide procedural guidance to contingent support staff
2+ yrs. as Enrollment Spec I
Increasing technical and project coordination skill set. Can field questions outside of technical expertise
Advancement to this and higher levels may also depend on meeting / exceeding assigned goals in quality and various management metrics,
Support / oversee the data gathering, requirements analysis and ADP project management activities associated with the maintenance of WFN/HRB and related interfaces/connections (i.e., the "technology deliverables") during the client's annual enrollment period (e.g., benefits open enrollment, etc.) across all ADP-related tasks and requirements for one or more product offerings. Own accountability for a client's successful enrollment process / event as it relates to the deliverables pertaining to the readiness of the technology/platform and associated integration
Coordinate and manage ADP-related resources and tasks. ADP tasks may include connection development and/or maintenance, enrollment/task training, data imports/migration/conversion, and applicable configuration of WFN/HRB or other ADP products (e.g. rate update or other internal tools) including coordination of contingent or off shore teams to supplement execution of tasks/activities
Secure / update / confirm appropriate information / materials from enrollment-related internal and external sources (e.g., brokers, carrier account managers, client leadership, etc.) to support the configuration of the WFN/HRB application and associated integration/connections resulting in a successful annual enrollment event
Manage all tools and resources related to the analysis and preparation of the platform that supports the enrollment process including required system/profile/information gathering, requirements analysis, system updates, quality testing, data migration, and resulting deliverables such as delivery of benefit cards, etc.. Serve as the "platform expert" to the Comprehensive Services organization for the given event
Perform special projects as determined necessary by the Enrollment Manager and/or Director of Annual Enrollment Services

Enrollment Specialist Resume Examples & Samples

Respond to questions from clients regarding EDI policy and procedures utilizing multiple tools and applications
Clear communication and education of associates on processes and procedures utilizing EDI functionality
Some contact with Client Partners when necessary
1+ years knowledge of medical computerized billing and scheduling software systems helpful
Oral and Written communication skills
Ability to pay close attention to detail and to ensure accuracy of reports and data
Ability to communicate with various business contacts in a professional and courteous manner
Computer and Internet literate
MS Office Suite - Excel
Adobe Acrobat
1-2 years office experience
Medical billing experience preferred ****

Senior Enrollment Specialist Resume Examples & Samples

Creating accurate and compliant enrollment materials while maintaining quality
Responsible for completion of web enrollment case set-up on the Prudential web enrollment platform, or by partnering with a third-party platform
Responsible for management of project timelines related to assigned enrollment requests, adhering to standard turnaround times and meeting all customer enrollment event deadlines
Acting as a consultant to Distribution partners on enrollment capabilities; understanding the varying levels of customization we can offer/accommodate and any corresponding risk that may be associated, setting expectations regarding timelines and customer touch points throughout enrollment planning and the end of the enrollment event
Acting as a subject matter expert representing enrollment on projects
Partnering with third party vendors and internal business partners to execute requests on time and to trouble shoot when issues may arise
Researching and resolving varying levels of complex enrollment requests and providing support to other team members, as needed
Responsible for relationship management with Distribution, Marketing, Compliance, Quality, Service and Product partners
Responsible for the Creation of and updating/maintaining SOPs for all enrollment activities
Producing and releasing enrollment participation summary reports
Prepares eligibility data for case set-up
Completes client review testing of both Web and Personalized Enrollment Kits
Responds to customer inquiries from the field and customers within established timeframes and performance standards
Supports reporting requirements for daily work assignments
Meets quality standards
Assesses issues and coordinates with other technical associates
Ensures compliance with regulatory and corporate requirements
Performs system testing as needed
Proven organizational skills with attention to detail
Proven analytical and problem-solving skills
Proven time management skills
Flexibility and responsiveness to change

Senior Enrollment Specialist Resume Examples & Samples

Responsible for the Creation of and updating/maintaining standard operating procedures for all enrollment activities
Experience supporting regulated products, understanding risk/compliance and legal aspects of such a business, Group Insurance/Voluntary product understanding a plus
Experience in directly supporting a sales organization; acting as a consultant on standard and non-standard offerings
Experience working in a deadline driving environment with peak periods
Strong written and oral communication skills (writing samples may be requested)
Strong analytical skills, proven experience trouble shooting complex technical systems; SPARC Platform experience a plus
5 year minimum prior experience

Rx Enrollment Specialist Resume Examples & Samples

1 year or more of experience in telesales, customer service, or retail sales
Availability to work between the hours of 8:30am and 6:30pm Monday-Friday (possible overtime, Saturday's, and some holidays) . Hours subject to change based on business needs
Associate’s or Bachelor’s Degree

Billng & Enrollment Specialist Resume Examples & Samples

Respond to barriers to perfect service in a consistent fashion, adhering to all regulatory requirements and internal processing timelines and guidelines
Build Humana’s brand image with employers, members, brokers, consultants, physicians, hospitals, regulators and legislators by providing effective and efficient service
Knowledge of Medicare and guidelines
Data entry skills and an analytical mindset
Ability to multi-task, detail oriented, with strong written & verbal communication
Strong proof reading and editing skills
Strong MS Access experience
Previous Enrollment experience
Previous audit experience
Bilingual Spanish & English

Open Enrollment Specialist Resume Examples & Samples

Resolve issues, inquiries, and concerns from members while treating them with empathy
Make outbound calls to members to complete the application process
Make outbound calls to providers for patient acceptance validation
Use attention to detail to ensure accuracy
Ability to adapt to change quickly

Enrollment Specialist Resume Examples & Samples

Minimum of 2+ years of customer service experience preferred
Basic knowledge of the Microsoft Office software
Excellent communication skills, both verbal and written, and interpersonal skills
Able to work with people from a variety of socio-economic and cultural backgrounds
Strong interpersonal skills with student and staff populations
Strong critical thinking skills, ability to work independently and make decisions based on general guidelines
Strong computer skills/experience required
Ability to work effectively under pressure and to meet frequently occurring deadlines
Ability to adapt to changing assignments and multiple priorities

Enrollment Specialist Resume Examples & Samples

High school degree or equivalent required or an equivalent combination of education and related work experience
Demonstrated knowledge and/or experience with Medicaid/Medicare rules and regulations
Experience with CMS and HRA Operating Systems
Basic computer knowledge including Microsoft (Word, Excel, Access and Outlook)
Ability to communicate effectively in front of small groups and in one-on-one discussions

Enrollment Specialist Resume Examples & Samples

Engage individuals telephonically in a consultative manner to develop value propositions that meet their needs
Manage a lead list and meeting enrollment goals
Engage professionals in medical facilities telephonically for education and patient-outreach initiatives
Perform administrative tasks in supporting of engagement operations
Job performance will be measured through a variety of metrics, including but not limited to enrollment rate and customer satisfaction scores
At least 1 year of experience in a customer service role; call center experience preferred
Exemplary listening skills
Ability to quickly develop rapport with individuals over the phone
Excellent customer service skills and a consultative sales approach
Self-starter with the ability to meet performance goals
Must have perseverance and willingness to make multiple attempts to engage individuals
Type a minimum of 30 words per minute
Familiarity with basic use of voice mail and electronic mail systems

Voluntary Enrollment Specialist Resume Examples & Samples

Supports enrollment activities on behalf of Group Insurance sales offices, and facilitates overall enrollment process for new and existing customers
Plans, organizes and facilitates the enrollment planning process to meet customer needs and maximize employee participation, while maintaining budget guidelines
Enrolls employee groups in voluntary products through various enrollment methods. Re-enrolls existing groups as required
Coordinates the development and delivery of case-specific enrollment material or supporting enrollment systems
Consults with Group Sales Representatives, brokers and employers to determine specialized customer communication needs. Communicates these needs to the Enrollment Support area
Supports the Group Sales office and operations where they are located when not enrolling
This position may require occasional standing or walking for extended periods of time
This position requires up to 75% travel, which may include flying and/or driving and some over night stays
Licensed agent or actively pursuing appropriate licenses
Working knowledge of competitor products and services
Knowledge and understanding of voluntary product enrollment procedures
Strong communication and human relations skills
Effective planning and organization skills, sound judgment, and attention to detail
Personal computer skills, including a working knowledge of various software packages, and excellent typing, spelling, and grammar skills
Understanding of the laws governing the insurance industry
Ability to travel 75% of the work period and a valid driver's license
Bilingual (English/Spanish) is preferred

Enrollment Specialist Resume Examples & Samples

Processes enrollment related transactions from various data sources
Researches and resolves member issues received from various different sources
Performs root cause analysis to determine issues related to member complaints and system errors
Phone interactions with members related to issue resolution
Identifies issue trends and opportunities for improvement
Required A High School or GED
Required 1+ year of experience in related field
Intermediate Ability to work as part of a team
Intermediate Ability to work in a fast paced environment with changing priorities
Intermediate Other Ability to communicate effectively and comprehend state and federal guidelines
Ability to identify basic problems and procedural irregularities, collect data, establish facts, and draw valid conclusions

Enrollment Specialist Resume Examples & Samples

Engage customer and broker contacts to ensure understanding of KP and how we serve consumers. Understand customer's business, challenges and needs and develop appropriate solutions. Identify key KP personnel who can enhance the business relationship. Proactively communicate advantages of KP and link to customer business needs. Keep customers informed on health care industry trends. Understand overall account strategy and implement a local communication plan that supports it. Plan and conduct customer meetings and presentations. Follow up on customer issues and concerns in a timely and accurate manner or refer to an appropriate team member. Understand the relationship between the union and management in the account. Identify key KP personnel who can enhance the business relationship
Analyze open enrollment opportunities and develop and execute strategies to maximize KP's visibility and membership growth. Evaluate group-specific needs for open enrollment meetings and presentations. Engage customer in identifying most appropriate approach. Coordinate activities and staffing for meetings and presentations. Work with account managers and group contacts to determine group specific open enrollment needs. Develop plan for acting on opportunities, execute, track and monitor plan throughout open enrollment season. Complete post-open enrollment analysis; identify lessons learned. Report analysis to account managers
Initiate any and all opportunities outside of open enrollment to engage with members and potential members to ensure understanding of and commitment to KP. Engage contacts to identify opportunities for KP visibility with employees. Develop and present proposals to account manager and contacts. Develop plan for acting on opportunities agreed to by contacts. Execute strategies and evaluate success
Engage broker & customer contacts to ensure understanding of KP technology tools (e.g. microsites, kp.org). Identify customers who have microsites and measure usage and update annually. Develop a microsite usage report that can be shared with the broker and customer. Develop plan for demonstrating kp.org to customer and their employees. Acquire and enter customer engagement data in a timely and accurate manner
Reinforce a culture of collaboration and accountability between sales, account management, product development, member marketing communications, case installation, local service area resources and other key internal partners. Review and document onboarding plan in conjunction with the Account Manager and Associate Account Manager. In conjunction with Sales, ensure that medical centers are aware of new group activity as appropriate. Track onboarding experience to uncover areas of improvement and develop/document best practices. Notify Account Manager about trends and urgent issues
Assist Account Management team as needed to assure timely processing of contract renewals. Understand the products and conditions of offering. Understand the accounts that are in the renewal process and the status of each.Provide administrative back-up support to the account team as needed
Minimum two (2) years of experience in sales and marketing
Health care industry experience preferred

Enrollment Specialist Resume Examples & Samples

Meets established arrival goals and quotas
Establishes and maintains liaison with public agencies and schools that might refer eligible candidates to the Job Corps program
Conducts weekly outreach activities to include presentations, meetings with groups, face to face contact with agency personnel, potential enrollees and parents, attendance at fairs, and office sites
Coordinates outreach assistance activities with other subcontracted individuals, agencies and government agencies
Prepares and implements a successful marketing plan. Media advertising should include radio, want ads in daily newspapers and weekly circulars, articles in newspapers, three-slide theater ads and literature distribution
Provides required information to each applicant, including zero tolerance policy and personal career development plan (PCDP)
Interviews interested candidates and obtain pertinent information on each one
Prepares and verifies required documentation and review with manager, OA/CTS. Ensure timely and correct input to OASIS system
Coordinates transportation services for new enrollees
Provides pre-arrival support for new enrollees for smooth transition and program retention
Provides students with basic direction, instruction and assistance in the career preparation period per approved program
Motivates and counsels students in areas of behavior, training, personal problems or study habits; coordinate with career development services and other staff as necessary to resolve issues affecting student training and adjustment to center life
Provides aptitude and interest assessments for students, to assist them in choosing an appropriate career pathway
Conducts weekly Pre-Enrollment meetings/tours. Provide support as needed to ensure maximum attendance
Follows-up on student progress; provide support in coordination with the center’s AWOL retrieval
Assists in the development and implementation of new and revised policies and procedures affecting student outreach, admissions and career preparation
Assists in community relations activities
Supports and promote center zero tolerance policies
Participates in student employability programs and activities
Promotes the development of career success standards by modeling appropriate behaviors, mentoring students when necessary and monitoring both positive and negative behaviors through interventions
Maintains accountability of students and property; adhere to safety practices
Performs related work as assigned

Electronic Enrollment Specialist, Eagan, MN Resume Examples & Samples

Requires H.S diploma or GED
3-5 years of related enrollment experience; or any combination of education and experience, which would provide an equivalent background
Expert in ENR eligibility system
Minimal DDS Enrollment experience is required

Enrollment Specialist Resume Examples & Samples

Must be self-directed and work with minimal supervision
Ability to manage multiple and varied tasks with enthusiasm and prioritize workload with attention to detail
BS or Associate Degree preferred or relevant work experience
BLS certification preferred

Open Enrollment Specialist Resume Examples & Samples

Conduct in-person presentations for large group client (100+) meetings for
Open enrollment, health fairs, biometric events, wellness events, etc
Ability to interact and educate clients, brokers, members and potential members face-to-face
Travel within your assigned territory (Northern and Central California) to attend and conduct on-site meetings in a timely manner. Attending meetings outside of your assigned territory is a possibility as well
Knowledgeable across all product lines (Fully Insured and ASO)
Medical: HMO, PPO, HSA, HRA
Specialty: Dental, Vision, Life, Disability
Wellness: Simply Engaged
Manage your assignment calendar. Be prepared with materials and client specific summaries for your meetings
Use UHC resources to educate yourself and others with regards to current health plan summaries, trends and new products
Use UHC internet sites to educate clients, brokers, members and potential members on how to navigate our systems, such as Myuhc.com and how to Find A Provider
Conduct WebEx presentations for large group client (100+) meetings for
Open enrollment, wellness events, etc
Manage your travel expenses and provide your expense report in an efficient and timely manner
Support Key Accounts team as a resource for product lines, network and wellness
Life, Accident & Health licensed in California
Must have a Life, Accident & Health license in California or must be able to obtain within 30 days of employment
Must have prior health care experience with HMO/PPO/HSA/Dental/Vision/Life/disability
Bachelor degree

Seasonal Enrollment Specialist Resume Examples & Samples

Prepare, process and maintain new and existing member enrollments and or disenrollment’s
Review and process demographic changes, death notifications and power of attorney notifications
Reconciling eligibility discrepancies, analyzing transactional data and submitting retroactive eligibility changes
Interpret and apply the CMS enrollment and eligibility rules and procedures
Research and reconcile the errors and rejections received on the weekly and monthly reports (e.g. TRR, RECON report). Determine the appropriate action, make manual corrections if needed and submit corrected transactions
Initiate and assist with developments/changes to increase quality and production
Act as back-up to the customer service team
Associates degree or equivalent experience required
Healthcare experience required
2 years of Enrollment Department experience preferred

Enrollment Specialist, Senior Resume Examples & Samples

Processes more complex enrollment related transactions from various different data sources
Researches and resolves financial membership and payment discrepancies. Identifies user errors and provides real-time feedback to associates
Serves as a subject matter expert and acts as a first line of contact for complex member issues received from various different sources
Performs detailed root cause analysis to determine core issues related to member complaints and system errors to resolution
Summarizes issues and recommendations for IT, Customer Service, and other areas, as appropriate, to perform corrective and preventative actions
Maintains data within various tracking tools related to outcome of research of various issues
Conducts phone interactions with members and may outreach to regulatory agencies
Read, understand and apply State and Federal Guidance to daily activities
Adhere to productivity, quality and compliance expectations
Provides support and guidance to Enrollment Specialists, analyzing and resolving member escalated issues
Works with the manager/supervisor to maintain daily workflow within the department to maximize productivity
Identifies issue trends and opportunities and assists on implementation
Preferred An Associate's Degree in a related field
Required Other Internal candidates: 18 months of experience with WellCare in a related field
Required Other External candidates: An associates degree plus 1 year in a related field or 3+ years experience in a related field without an associates degree
Intermediate Ability to effectively present information and respond to questions from peers and management Critical thinker

Enrollment Specialist Resume Examples & Samples

Maintain a current knowledge of State and Federal regulations
Perform basic clerical functions with proficient PC skills
Research and resolve escalated inquires/issues that are more complex
Perform outbound member calls and miscellaneous projects as necessary
Work cross-functionally with other departments to develop or review processes and to resolve member issues
Medicare or Medicare Advantage experience preferred

Enrollment Specialist Resume Examples & Samples

Engage customer and broker contacts to ensure understanding and commitment to KP and how we serve consumers
Identify the key personnel, the functions they perform, their role in the Direct Marketing process and their opinions about KP in conjunction with the Account Manager/Executive Account Manager
Understand customer's business and business challenges
Proactively communicate advantages of KP and link to customer business needs
Identify customer needs
Understand overall account strategy
Plan and conduct meetings and presentations for any of the products offered by KP
Responds to questions from potential and current members
Follow up on customer issues and concerns in a timely and accurate manner or refer to an appropriate team member
Support open enrollment opportunities and execute on strategies to maximize KP's visibility and membership growth
Coordinate activities and staffing for meetings and presentations
Work with account managers and group contacts to determine group specific open enrollment needs
Understand / execution open enrollment plan. Identify and secure resources needed to execute plan
Facilitate enrollment activities by representing KP
Transport enrollment materials and promotional items to meetings and presentations, Track and monitor plan and enrollment activities throughout open enrollment season
Complete post-open enrollment analysis; identify lessons learned
Report analysis to account managers
Understand KP technology tools (e.g. kp.org., My Health Manager, KP Mobile Apps, microsites ) and know how to use and demonstrate them
Acquire and enter customer engagement data in a timely and accurate manner
Collect competitor information at the worksite as appropriate
Enter competitor information into Sales Connect as needed
Reinforce a culture of collaboration and accountability between sales, account management, product development, member marketing communications, case installation, local service area resources and other key internal partners
Minimum one (1) year experience in marketing, business development, customer service, consumer sales, account management or sales
HealthCare experience

Open Enrollment Specialist Resume Examples & Samples

Use UHC internet sites to educate clients, brokers, members and potential members on how to navigate our systems, such as Myuhc.com and how to find a Provider
Must have a Life, Accident & Health License in California or the ability to obtain it within 30 days of employment
Must have prior Healthcare experience with HMO/PPO/HSA/Dental/Vision/Life/Disability
Available to travel 75% of the time

Enrollment Specialist Resume Examples & Samples

Engage patients and their families telephonically in a consultative manner to help them understand the value of our programs and the opportunities available to them
Answer patients and their families’ questions on benefits of the program and the enrollment process
Manage a lead list and achieve monthly enrollment targets
Perform key administrative tasks in support of program enrollment goals
Deliver exceptional service over the phone to patients
Demonstrate exceptional customer service by acting in accordance with the DaVita, Inc. mission and values
At least one year in a telephonic customer experience role, healthcare field experience preferred
Strong coordination skills and ability to work in a cross-functional team to manage complex patients
Must have perseverance and consultant-like mind-set to make multiple attempts to engage patients
Commitment to act and speak in accordance with the DaVita, Inc. mission and values

Contact Center Enrollment Specialist Resume Examples & Samples

High School Diploma/GED Required, and AA or BA Preferred
Excellent written and verbal communication skills with ability to document content of phone conversations accurately
Exceptional organizational and time management skills necessary, in addition to the ability to work closely with other team members and departments
Typing proficiency of 35 wpm/and above average data entry skills required
Proficiency in basic Microsoft applications (must know Outlook and Word at a minimum)
Ability to determine needs of the caller and obtain necessary information without following a scripted process

Enrollment Specialist Resume Examples & Samples

Evaluates new case and add-on risks, assuring timely and quality underwriting by
Read, comprehend, and interpret underwriting procedures, requirements, regulations, and contracts
Maintain complete confidentiality of information
Work in and contribute to a positive team environment
Complete tasks on time while managing multiple tasks simultaneously

Enrollment Specialist Resume Examples & Samples

Speak with members (inbound/outbound) about the "Quit for Life" stop smoking program
This is a telephone position with the Registration Department
Ability to handle a high volume of of calls
Demonstrate ability to sell a service or product effectively
Demonstrate ability to effectively communicate
Must be abstinent from tobacco or nicotine use for two or more years
Values and practices the basic elements of a healthy lifestyle
Demonstrated dependability and professional demeanor
Comfortable working an 8 hour shift between 1:00 pm - 9:30 pm in candidate time zone with at least 1 weekend day (schedule will be set) with holidays possible
Experience using a computer and Microsoft Office (Word, Excel, and Outlook)
6+ months Customer Service experience
2+ years Tobacco and Nicotine free
Bachelor’s Degree (or higher)
Experience working in a Call Center environment
Experience in a Clerical or Administrative Support related role
Bilingual with English and Spanish

Enrollment Specialist Resume Examples & Samples

Following established enrollment procedures and sound practice directly or by working with Enrollment Coordinators, prepares applications for all new providers for multiple contracts sites, payors and states requiring an acute attention to detail, accuracy and knowledge of complex and varied requirements. Review applications for completeness, flag missing information and signatures before sending the pre-populated applications to the providers for completion. Track and follow up on a timely basis to ensure completion of application process and submission to payor for approval
Extensive and frequent verbal and written communications with Clinicians, state payors, insurance carriers, third party billing company and internal company staff requiring professionalism and tact to attain or provide all needed information quickly in order to expedite the enrollment of Clinicians in the various plans to maximize billing opportunities. Acts proactively and builds strong relationships with payors to facilitate enrollment and obtain provider billing numbers
Utilizes templates or prepares correspondence inserting proper provider and group related information for submission of applications to payors. Anticipate payor needs, proactively address and resolve issues with payors to ensure prompt approval of applications
Works with in-house and third party Billing Company for current applications, system updates and identifying/resolving problems. Handles corrections or rejections of claims due to enrollment errors and/or claim submission requirements. Conveys issues and status of problems to Enrollment Management. Ensures Held A/R enrollments are submitted on timely basis to avoid risk of claims/adjustments and an unnecessary increase of Held AR. Maintain and work reports of non-compliant providers and held A/R to maximize income opportunities
Accountable for meeting or exceeding divisional and/or corporate Enrollment performance standards and meeting time-sensitive deadlines as defined. Update status of application in system data bases and in excel reports for accurate reporting
Works independently within the scope of responsibility and authority. Understands and follows state and payor requirements, some of which are quite complex, and determines which applications require management approval or special processing requirements. Able to work with high volume enrollments while multi-tasking and driving provider enrollments through completion. (example: 10 contracts with 40 providers per contract)
Adheres to all company policies and procedures
Two years previous enrollment or related experience preferred
Government healthcare payor experience is preferred
Database and excel spreadsheet experience is a must
Effective oral, written and interpersonal communication skills, strong telephone skills

Enrollment Specialist Resume Examples & Samples

Following established enrollment procedures and sound practice directly, prepares applications for all new providers for multiple contracts sites, payors and states requiring an acute attention to detail, accuracy and knowledge of complex and varied requirements. Review applications for completeness, flag missing information and signatures before sending the pre-populated applications to the providers for completion. Track and follow up on a timely basis to ensure completion of application process and submission to payor for approval
Coordinates the maintenance of the division contract database; tracks new contracts through the review and approval process
Ensures divisional personnel have access to information for managing divisional contracting activities; including, provider onboarding, RCM processing, and release / refile of held A/R
Supports the divisions private healthcare payor contract effort by performing ad hoc contract negotiations, reviewing contract language, maintaining the practice management operations software, managed care contracting lists, and facilitating communication among the division and private healthcare payors

Enrollment Specialist Resume Examples & Samples

Prepare applications for all new providers for up to 10-12 divisional contracts
Send pre-populated applications to the providers for completion
Requires acute detail-orientation for responsibility of accuracy of forms and information pre-populated on the enrollment applications
Track and follow up with providers for timely return of all required documents and applications
Submit applications to payors
Track and follow up with payors to obtain provider numbers
Build relationship with divisional payors to facilitate enrollment
Proactive on resolution with payors
Work with Billing Company for current applications and system updates
Maintain and work reports of non-compliant providers and held A/R
Strong computer skills in Microsoft Word, Excel and databases. (Intermediate level)
Daily work with Excel spreadsheets in managing providers, contracts and payors
Develop strong working knowledge of payor policies for multiple states
Ability to work with high volume enrollments. (example: 10 contracts with 40 providers per contract)
Responsible for significant large dollar amounts in Held AR
Establish strong relationships with team members
Resourceful working under pressure in a fast-paced team environment
Capable of meeting time-sensitive deadlines and multi-tasking. (timely filing of applications)
Accountable for corrections or rejections of claims due to enrollment errors
May substitute equivalent work experience
Two years previous enrollment experience preferred
Database experience is a must
Strong telephone skills
Microsoft Word and Excel experience is required

Enrollment Specialist Resume Examples & Samples

Prepare applications for all new providers
Request and organize supporting documentation to accompany various provider enrollment applications from multiple departments, including but not limited to: Operations, Corporate Compliance, Legal, Tax, PBS, etc
Maintain and/or make corrections to existing provider files
Request new bank accounts and complete the set up of Electronic File Transfers
Track and follow-up to obtain new provider numbers
Submit applications to carriers
Complete and update all 855B forms every 90 days
Maintain database of all licensing and vehicle registrations for all operation locations
Build relationships with AMR employees and regional payors to facilitate enrollment
Research enrollment requirements by payor
Develop working knowledge of payor policies, requirements and necessary forms for multiple states
Complete and update all Medicaid required enrollment forms as required by each carrier
Participate in internal and/or external meetings
Resolve customer inquiries
Communicate to management all changes in Medicare and Medicaid enrollment requirements
Maintain confidentiality at all times in accordance with HIPPA guidelines
Adhere to and comply with information systems security. Know and follow Information Systems security policies and procedures, attend Information Systems security training, and report information systems security problems if identified
Minimum of one year experience in third party billing; knowledge of Medicare, Medicaid, and regulations is preferred
Minimum of one year experience provider enrollment is preferred
Knowledge of Zoll, AM200, Jaguar preferred
Flexible, high achiever with ability to learn quickly and meet department goals and deadlines consecutively
Familiarity and proficiency with the policies and procedures of the Enrollment department
Working knowledge of payor policies and PBS’s billing procedures
Extensive knowledge of state enrollment applications and guidelines
Working knowledge of internal billing systems
Working knowledge of PC applications (MS Office and Edison)
Knowledge of HIPPA requirements
Organized, detail oriented with excellent follow through abilities. Can handle and prioritize multiple tasks. Reliable, team-oriented, pleasant with excellent interpersonal skills
Excellent communication skills both on the telephone and personally
Effective oral, written and interpersonal communication skills Intermediate to advanced skill level in Internet Explorer, Microsoft Outlook, Word, Excel and Access for Windows
Type 45 wpm and 10-key by touch

Administrative Enrollment Specialist Resume Examples & Samples

Provides enrollment assistance for assigned groups including qualifying events with follow-through, new employees and terminations, researches and confirms eligibility, updates information and orders cards, and documents all actions in Benefit Advocate Tool
Assists department with administrative tasks including copy projects, faxing and scanning, mailing, creation of notebooks, folders and files, updates Outlook folder for client information, database entry, and printing on-line directories
Handles daily filing and archival of call logs
Answers telephone and routes calls to others; operates fax machines, scanners, printers and copiers
Reviews “my benefits” emails and distributes issues in Manager’s absence
Provides follow-up of claims issues as requested by Benefit Advocates
Maintains the Benefit Advocate bios and customized announcements
Creates, runs and prints reports as requested
Follows all HIPAA requirements specific to department including keeping up to date with HIPAA requirements and training as required, and filling all paper logs each day
Attends meetings and participates in group discussions and decisions; transcribes and organizes meeting minutes
Attends all department trainings by outside and Alliant personnel as appropriate
1 - 3 years of experience in Benefits dealing with carrier enrollment

LTC Enrollment Specialist Resume Examples & Samples

Conducts home visit(s) to educate applicant, family and/or applicant's caregiver(s) on program benefits and design
Identifies applicant's health needs and completes medical assessments of applicant
Utilizes WellCare designated criteria along with clinical knowledge and expertise to develop personalized plan of care
Initiates direct communication with health care providers involved in the care of the applicant to obtain complete and accurate information needed to complete plan of care
Negotiates appropriate care plan based on health assessments with health care providers, member and caregiver
Collects information concerning eligibility, provider status, benefit coverage, and coordination of benefits
Inputs visit and assessment data into systems
Adhere to all HIPPA standards and confidentiality requirements
Bilingual skills, preferred
Valid Drivers license may be required

Payor Enrollment Specialist Resume Examples & Samples

Coordinates the enrollment and registration process for both new payor enrollments as well as updates for providers already enrolled with the payors.Prevent issues with billing by assuring applications are complete and accurate.Maintain current and accurate data in the Share Point database.Update the internal tracking spreadsheet on the enrollment shared drive as payor applications are mailed to the payors, approvals are received and the date the department contact was notified of the approval.Track the status of applications submitted to the government and commercial payors
Physicians:Medicare, Medicaid, Tricare, Workers’ Comp and Sidney Hillman
Advanced Practice Practitioners (APP):Medicare, Medicaid, Tricare, Fidelis, MVP, Blue Cross/Blue Shield of Western New York, Excellus and Univera
Name changes
Address Updates
Collaborating or Supervising Physician updates
Linking the provider to additional or new Tax ID/Group NPI#s
Adding new practice addresses to existing group Tax ID#s/NPI#s for acquisitions and newly established practice addresses
Changing the “Category of Service” codes with Medicaid for groups as required (example: changing a group comprised of physicians, nurse practitioners and physician assistants to a multi-professional group (such as adding podiatrists to the group)
Complete applications in response to Medicare and Medicaid revalidation requests for both individual and groups
Work with Billing Managers to secure enrollment related information.Act as the liaison in direct responding to health care professionals and their department regarding the status of the application process
Notify department contacts when confirmation is received from the payers that a provider has been enrolled and approved
Assure confidentiality of documents, records and data information.Identify and report any non-compliance to manager immediately
2 years of post high school education in secretarial studies or the equivalent. At least 3 years of secretarial and office experience, including 1 year in a position which demonstrated the ability to work with minimum supervision and to direct an office operation

Annual Enrollment Specialist Resume Examples & Samples

Review case-set requests (enrollment team, broker, client, sales office, etc) to ensure all needed information is received
Request any information needed to complete the set-up
Code internal systems (Case Manager) with request information
Collaborate with off-shore team (Cap-Gemini) to complete request
Complete the work task by coordinating with the requestor and providing a Member Deduction Report (MDR)
Audit work tasks to ensure accuracy
Strong and effective customer service skills and experience
In-depth knowledge of Group Insurance enrollment and administrative processes
Ability to resolve routine service issues
Ability to develop and maintain effective, professional business relationships with internal and external customers
Demonstrated ability to work independently and effectively in a multi-site organization
Ability to dependably meet time-sensitive deadlines under pressure while producing quality work

Lead Enrollment Specialist Resume Examples & Samples

Review Held Account Receivables on a semi-monthly basis for all applications processed by the third party including EmBillz reports
Mentor and assist in training for Enrollment Specialists and coordinators who have roles in applications processed through the third party
Monitor work flow activities in the recruiting, credentialing and enrollment departments for activities related to application processing through the third party
Analyze trends and processes and prepare periodic reports to management for monitoring current third party enrollment activities as well as identifying problem areas that need attention and improvement
Participate in third party enrollment processing training for division and national enrollment staff as well as credentialing and recruiting staff. Training may be formal or as needed for existing staff and new hires
Identify problems and present recommendations for improvements; implement and monitor those recommendations
Prepare and finalize Scorecard and core reports including documenting results of analysis for management review
Liaison between EmCare and the third party processor for development of new, and modification of existing, management reports
Liaison between the third party processor and recruiting, credentialing and enrollment departs for problem escalation, follow through and resolution
Track application status and progress throughout the enrollment process for applications processed by the third party. Daily and weekly reporting on progress activity to senior management and other departments
Ensure compliance quality assurance/maintenance of third party enrollment processes
Maintain high level of organization while being extremely focused on detail. Requires acute detail-orientation for responsibility of accuracy of forms and information pre-populated on the enrollment applications
Establish strong relationships with team members and 3rd party processor
Exhibit resourcefulness working under pressure in a fast-paced team environment
Ability to meet time-sensitive deadlines and multi-task in a changing healthcare environment
Be able to troubleshoot and problem-solve
Be able to effectively use the company-based software

Enrollment Specialist Resume Examples & Samples

Screen customer requests for all enrollment and evidence of insurability methods to ensure compliance with contractual provisions and risk rules
Prepare/format and process electronic enrollments and evidence of insurability to ensure coding to administrative system
Attain individual/team productivity goals without compromising accuracy, service, or the privacy of our customers
Manage daily work activity and take action as appropriate to meet customer service metrics
Operate as a team player, e.g. provide and receive feedback, deal with conflict, support others, arrange for or provide back-up support as necessary
Research and resolve customer inquiries which may include audit of employee coverages and eligibility criteria
Partner with external and internal resources to ensure a successful implementation of enrollment strategy for each customer
Educate internal partners and customers on expectations for data delivery, procedures, workflow and customer centric metrics
Responsible for developing partnerships and working effectively and collaboratively with all customer service partners regarding enrollment and/or EOI issues
Identify and communicate administrative trends and collaborate as needed to resolve service issues and find ways to improve the customer experience and make it easier for our customers to do business with Unum
Evaluate and resolve service issues with an appropriate sense of urgency relying on exceptional communication skills, strong product and process knowledge
Performs situational business analysis/problem solving as it relates to the enrollment strategy and EE coverage
Represents functional area on projects to effectively communicate business needs
Assists in development and/or maintenance of training/user/system manuals
Process applications in product lines utilizing multiple systems
Provide support to Medical Underwriters during the evidence of insurability process

Hipp Enrollment Specialist Resume Examples & Samples

Responds to incoming calls from clients
Reviews and evaluates client information such as paystubs, group insurance information and other documentation to determine client eligibility for the HIPP program
Contacts employers and Medicaid clients to coordinate enrollment in HIPP Program
Performs research to locate group insurance information needed to complete case reviews
Communicates with insurance carriers to verify coverage
Observes professional standards of conduct, including attendance, professional behavior and dress code
Develops and maintains professional business relationships through verbal and written communication with team members, employers, Medicaid clients and insurance companies
Shift 9am to 6pm
One year of insurance experience
Ability to manage workflows
Problem solving and critical thinking

Enrollment Specialist Resume Examples & Samples

Assures accuracy in eligibility and enrollment processing and makes decisions in the best interest of protecting the integrity of the client’s business needs
Detailed documentation of communications for tracking and follow up processes
Maintain excel spreadsheets for Initial and Renewal enrollments that correlate to creating tickets for system issues and various requests
Collaborate with Financial Analysts for Small Business enrollment billing and invoicing, and Carrier research for customer support
Follows all pertinent policies and procedures
Functions positively in a technological and team-based environment
Makes suggestions for improvements throughout the business process
Follows all guidelines in compliance with security and privacy standards, inclusive of but not limited to Federal Tax Information (FTI), Personal Health Information (PHI), and HIPPA Health Insurance Portability and Accountability Act (HIPPA)
Maintains production standards
Performs additional business operations duties as required

LTC Enrollment Specialist Resume Examples & Samples

Conduct home visit(s) to educate applicant, family and/or applicant’s caregiver(s) on program benefits and design
Identify applicant’s health needs and complete medical assessment of applicant
Utilize WellCare designated criteria along with clinical knowledge to develop personalized plan of care
Initiate direct communication with health care providers involved in the care of the applicant to obtain complete and accurate information needed to complete plan of care
Negotiate appropriate care plan based on health assessments with health care providers, member and caregiver
Collect information concerning eligibility, provider status, benefit coverage, and coordination of benefits
Input visit and assessment data into systems
Required An Associate's Degree in Nursing
Preferred A Bachelor's Degree in Nursing or related field
Required 4+ years of experience in A clinical acute care setting, preferably in home health and/or geriatrics
Required Other Current case management experience
Preferred Other Public speaking and health education experience
Intermediate Ability to effectively present information and respond to questions from peers and management
Intermediate Ability to identify basic problems and procedural irregularities, collect data, establish facts, and draw valid conclusions
Intermediate Ability to influence internal and external constituents
Intermediate Ability to represent the company with external constituents
Intermediate Demonstrated customer service skills
Intermediate Ability to create, review and interpret treatment plans

Enrollment Specialist Resume Examples & Samples

Develop volunteer recruitment strategies, to include a marketing plan, community outreach initiatives, etc. for assigned projects and /or populations of interest
Execute and actively participate in study specific and special population recruitment efforts, study-specific marketing, community outreach (i.e. language schools, community centers, senior centers, markets, etc.)
Provide leadership and guidance w/n an ethnic initiative, as assigned (i.e. either Hispanic, Korean, Armenian)
Provide support, mentorship, and training to Enrollment team
Maintain contact with sponsor team members and participate in relevant meetings (may require travel), as needed
Assist with the creation, review, revision, and/or retirement of Standard Operating Procedures, as assigned. Also participate in implementation and training once finalized
Coordinate and assume responsibility for participant enrollment, care, and study assignment
Screen potential clinical trial volunteers according to protocol specific requirements and CFR/ICH GCP guidelines. Ensure all study laboratory and medical tests are completed and the eligibility requirements specific to assigned studies are met
Ensure all established timelines relating to area of responsibility and assigned projects are met
Must be self directed and work with minimal supervision
Bilingual preferred (English and at least 1 of the following: Japanese, Chinese, Korean, Spanish, or Armenian)
At least 2-4 years related experience or relevant work experience
Computer skills and familiarity with research process is highly desirable
Physical Requirement: Manual dexterity, visual and auditory acuity

Enrollment Specialist Resume Examples & Samples

Bachelor Degree in related field/business degree or equivalent experience required
A valid driver’s license and a reliable vehicle that is insured
Bi-Lingual (Spanish) Preferred
Knowledge of psychosocial aspects of aging
Strong sales skills especially the art of closing

Enrollment Specialist Resume Examples & Samples

Ability to analyze information to make appropriate decisions regarding enrollment/disenrollment, complying with applicable regulations and governance
Ability to make eligibility determinations based on CMS (Part A/Part B Eligibility), DPW (Medical Assistance Eligibility), and/or PID requirements, in accordance with the application election period guidelines. Ability to accurately identify appropriate election period based upon analysis of beneficiary/member history and regulatory guidance
Comprehension and application of eligibility regulations to process enrollment transactions and generation of corresponding letters to members. Must keep up to date with new regulations and guidance
Daily clerical responsibilities related to processing and electronic storage of member correspondence
Identify areas of concern or trends that may compromise client satisfaction or compliance with government regulations
Initiation and generate of appropriate correspondence based on type of transaction processed, includes initiation of outreach requests and written correspondence (letters), as necessary
Interact with Sales staff to ensure all required date elements for completed application are received and any issues are addressed timely, in accordance with compliance requirements
Maintain employee/insured confidentiality
Process all types of enrollment and disenrollment transactions in accordance with company policies and procedures in a timely manner while meeting production and quality goals
Support team projects within Enrollment Services; other projects as assigned
Understanding of varied and detailed enrollment and disenrollment requirements and processing rules based upon the product (HMO, PPO, EPO, SNP, PDP, Select, Supplemental, or National Complimentary) and Individual vs. Employer Group, including, but not limited to, understanding and application of service areas by product
High school graduate or equivalent required, college degree preferred
Minimum of six months of customer service and/or call center experience
Ability to interpret and apply complex eligibility regulations as mandated by CMS, DPW, and PID
Demonstrates good organizational, interpersonal, leadership and communication skills
Attention to detail is critical to the success of this position, with skills in customer orientation
Will need to manage multiple tasks and projects
Microsoft Office/PC skills required
Bachelor's degree is strongly preferred

Enrollment Specialist Resume Examples & Samples

Communicate with Patients and Patients Representatives to resolve healthcare accounts while offering excellent customer service
Maintain diplomacy when addressing matters escalated
Provide thorough, efficient, and accurate documentation and updates in all required systems for each work event
Responsible for meeting monthly goals and quality standards through efficient and accurate work processes
Review open accounts to determine and take appropriate actions through understanding charges, billed claims, payments, denials, adjustments, and refunds
Respond to verbal and/or written inquiries in a timely manner
Process all correspondences with adherence with the Health Insurance Portability and Accountability Act (HIPAA) guidelines where applicable
Knowledge, understanding, and compliance with company policies and procedures
High School Diploma or General Educational Development (GED) certificate or equivalent in relevant work experience desired
Previous customer service and healthcare receivables experience preferred
Understanding of health insurance providers, Workers' Compensation, Medicare, Medicaid, and liability claims processes and contracts
Ability to maintain the highest level of confidentiality
Proficient personal computer skills
Ability to work in a multi-tasked environment
Ability to prioritize and organize work

Enrollment Specialist, Starmou Resume Examples & Samples

Enter enrollment and eligibility information into the database
Update, maintain and retrieve enrollment and eligibility information
Respond to inquiries regarding enrollment as needed
Ability to input enrollment data quickly and accurately
Familiarity with Microsoft Office and Internet research
Minimum 1-3 years data entry experience

VA Ltss Member Enrollment Specialist Resume Examples & Samples

Effectively supports Magellan?s SBU program operations ensuring that data is entered accurately and timely as required by contract service level agreements. Communicates with appropriate contacts on eligibility issues and questions. Answers incoming calls on eligibility, program benefits, plan limitations and point of sale edits from providers. Proficient use of enrollment and claims point of sale for research and problem resolution
Assists in data collection and reporting. Completes bi-weekly checkwrite production for provider payment in the accounts payable system, reporting all operational issues and assisting with system issues
Assists with quality monitoring and provides constructive feedback. Reviews production reports, identifies issues and recommends resolutions; continually seeks to improve processes and increase efficiencies
Assists in data collection and reporting
Other special projects as required by management

Enrollment Specialist Resume Examples & Samples

Prepare, process and maintain new and existing member enrollments and or disenrollment records. With daily analysis and correction of enrollment files and data migrated from one data source to another. 50%
Research and reconcile eligibilities discrepancies, errors and rejections received on the daily, weekly and monthly reports (e.g. TRR, RECON report). Determine the appropriate action, make manual corrections and if needed, submit corrected transactions. 30%
Work cross-functionally with other departments to develop or review processes and to resolve member issues. 10%
Assume responsibility for related duties as required or assigned. 10%
Associates degree or equivalent experience preferred
Enrollment Department experience preferred

Enrollment Specialist Resume Examples & Samples

Process member enrollment and change forms
Audit enrollment accuracy
Meet or exceed performance/audit metrics
Make/take phone calls as needed to complete job duties
Resolve member complaints timely
Resolve issues routed from other teams via email or systematically
Maintain various databases
Keep self-updated on related CMS changes
Effectively understand and navigate multiple systems
Complies with all guidelines established by the Centers for Medicare and Medicaid (CMS) and guidelines set forth by other
Professional verbal and written communication skills, with the ability to clearly articulate thoughts and ideas
Customer service skills with the ability to interact professionally and effectively with providers, third party payers, physicians, and
One year of recent/relevant experience
Demonstrated experience in a data entry role
Experience in healthcare industry, understanding of terminology and definitions
Understanding of CMS guidelines for Medicare Advantage enrollment processes
Personal computer experience should include working with Microsoft Word, Excel, PowerPoint, Access, and Outlook at the

Open Enrollment Specialist, HRB Resume Examples & Samples

Coach other ADP associates impacting the enrollment process to ensure consistent client service levels during peak periods
Perform special projects as determined necessary by the Open Enrollment Management Team
3 years' experience as an ADP Major Accounts HR and Benefits Services Client Support Specialist
Previous rotation in OE is strongly preferred
In-depth knowledge of ADPs HRB products (WFN, HRB,ADPR)
Demonstrated client conflict resolution skills necessary
2 yrs HRIS, Client Support, or Benefits Administration and project coordination experience in a BPO environment

Enrollment Specialist Resume Examples & Samples

Demonstrated proficiency on 10 key
Demonstrated 40 wpm tying skills with 95% accuracy
Ability to express ideas and recommendations clearly and with a high level of professionalism in written and oral communications
Proficiency with Microsoft Office software
Ability to work in an Imaging environment
Ability to work in a web based environment
Ability to think analytically and to make sound judgments from analysis
Ability to plan and organize own work
Ability to work flexible hours during periods of heavy workloads
Ability to exercise judgment, initiative and discretion in confidential, mature and sensitive manner

Enrollment Specialist Resume Examples & Samples

Determine eligibility and perform various enrollment and disenrollment processes for related plan members to ensure compliance
Engage in accurate and timely resolution of issues and functions with minimal direction
Anticipate workflow needs based on CMS Guidance, established processes, policy and procedures
Partner cross functionally with various operational business units while supporting departmental objectives within company and regulatory guidelines
Process all related account maintenance tasks
Accomplish daily enrollment/ disenrollment operations
Obtain missing information for enrollment completion. Coordinate process within required timeframes
Initiate corrections to CMS or RPC
Review related monthly CMS reports. Compare reports to eligibility file and resolve any discrepancies with member status data
Determine extent of and reason for discrepancy
Coordinate with Sales & Marketing department on initial application process
Conduct root cause analysis on issues and supports resolution of related enrollment-related grievances and CTMs
Responsible for review of related training and reference materials
Previous experience in Medicare, health insurance preferred
Excellent customer/interpersonal skills
Detail oriented with strong analytical and organizational skills
Knowledge of related systems preferred

Enrollment Specialist Resume Examples & Samples

Develop project plans and manage logistics for special initiatives related to marketing, recruitment, and enrollment management
Assist with enrollment event planning & execution including, but not limited to, open houses, information session, special lecture events for recruiting, graduate and career fairs, web chats, telephone recruitment initiatives, special events, orientation and registration
Participate in the new program proposal and launch process: evaluate need, conduct market research, and develop documentation and program launch plans
Work with Director of Enrollment Management on new student success initiatives & programs
Assist with the implementation & cultivation of on-campus graduate student resources
Network with professional organizations and feeder programs to develop program & brand awareness
Partner with university administrative offices to design and implement support services for online and continuing education students
Proficiency with reporting, data visualizations & data analysis is strongly preferred
Develops effective written communications and uses them appropriately. Will act as

Enrollment Specialist Resume Examples & Samples

Minimum of six months of customer service and/or call center experience preferred
Microsoft Office/PC skills preferred
Fluency in Spanish is preferred
Previous work experience with an analytical focus is preferred

Enrollment Specialist Resume Examples & Samples

Process work items according to appropriate regulatory guidelines
Review files and interpret the data to enter members into eligibility systems
Completion of daily change file pre-processor exceptions and monthly full file pre-processor exceptions
Research member eligibility and take appropriate actions to resolve issues across all eligibility systems
Process mass Primary Care Physician (PCP) changes with Provider Operations
Research, review, and interpret eligibility data to respond to eligibility inquiries from contracted vendors
Access state and federal government systems to review and confirm eligibility status
Process paper applications received for all applicable lines of business
Inbound phone coverage to answer inquiries from both internal and external customers
Complete all required corporate training within stated timelines to a satisfactory manner
Associate’s degree in accounting, finance or business related field or equivalent work experience is preferred
Minimum of two (2) years of healthcare, insurance, or related industry experience to include at least one (1) year of enrollment/eligibility or similar experience is required
Familiarity with Microsoft Word and Excel
Familiarity of the healthcare field
Knowledge of Medicaid and Medicare preferred
Proper phone etiquette
Decision making/problem solving

Enrollment Specialist Resume Examples & Samples

3+ years’ experience in enrollment/eligibility or transaction related operations
Enrollment/Eligibility experience preferred
Knowledge of health care operations and structure, general requirements in an integrated delivery system, and use of information system applications in a health insurance or health care environment
Ability to be involved in multiple projects at the same time
Excellent organization skills; ability to prioritize multiple activities and objectives in a rapidly changing environment, and deliver quality service
Strong skills in word processing, spreadsheet and presentation computer programs, preferably Microsoft
Knowledge of health insurance concepts related to enrollment and eligibility practices
Must have knowledge of database management and data accuracy verification techniques
Medicare/MediCal experience is desired
Must possess some familiarity and understanding of DMHC regulations, various health care reimbursement models, pricing mechanisms, managed care and payer relationships
Required skills include ability to build collaborative working relationships with diverse individuals and organizations; strong analytical and problem solving skills; ability to operate independently and confidentially
Familiarity with relevant file layouts (e.g., FSA Type 6; GSF; spreadsheet solutions; 834 5010; etc.) for enrollment system uploads

Senior Enrollment Specialist Resume Examples & Samples

Facilitates timely enrollment of new providers in health plans and existing providers in newly contracted health care plans including compilation of confidential data . Maintains knowledge of NCQA standards and health plan enrollment and credentialing guidelines (including Medicare and Medicaid)
Compiles accurate health plan application packets for the many different Members of BIDCO, keeping abreast of the numerous changes in application and licensure documentation. Reviews returned applications for accuracy and completeness prior to submission to the health plans
Performs recredentialing of BIDCO providers every 2 years so that providers may continue to bill for services rendered. Coordinates with departments to distribute recredentialing applications and reminders, tracking all providers to completion within anticipated target dates
Inputs enrollment information into the provider database at time of initial enrollment, and for any ongoing changes. Maintains accuracy and completeness of provider database in accordance with uniform nomenclature
Communicates directly with health plans, clinicians and BIDCO practice staff. Develops and implements reporting mechanisms to keep providers and administrators apprised of providers' health care plan status, working with them to ensure completion of enrollment with health plans within anticipated target date
Provider Enrollment experience is strongly preferred
Knowledge of Medicare, Medicaid and health plan credentialing, recredentialing and enrollment process; licensure requirements and regulations of various agencies such as the board of Registration in Medicine, American Board of Medical Specialties and Individual Specialty Boards preferred normally acquired through related work experience
Independence of Action:Ability to follow precedents and procedures. May set priorities and organize work within general guidelines. Seeks assistance when confronted with difficult and/or unpredictable situations. Work progress is monitored by supervisor/manager

Participant Enrollment Specialist Resume Examples & Samples

Maintain and monitor participant product account information including enrollment,
Provide back up to Client Enrollment Specialists as needed
Associate's degree or equivalent from two-year college, or technical school or equivalent combination of education and experience
1-2 years of related experience in enrollment services
Experience working with highly sensitive information in a confidential manner
Proven ability to adapt to changing business software applications and processes

Urgent Enrollment Specialist Resume Examples & Samples

Responds to urgent engagement requests within the Crisis Response Center and other community settings to complete intake assessments, including full ICC Demographic or 834 enrollment
Completes AHCCCS and Healthcare Marketplace screenings as needed with members
Follows up with coordination of care as needed to ensure appropriate first appointments are scheduled
Completes progress notes, other patient record documents and writes comprehensive and timely reports/assessments in accordance with agency and funding source guidelines
Assists in coordinating and planning out of home placements and discharges
Accurately reads, records and interprets information, including assessments, measures, and diagnostic criteria
Completes all required training by licensing, agency, and funding source or as requested by supervisor and participates in individual and team clinical supervision

Open Enrollment Specialist HRB Resume Examples & Samples

Serve as subject matter expert in handling routine client requests
Resolve routine customer concerns with pre-defined solutions
Lead workflows and determine procedures for the group as appropriate
Develop and leverage a broad understanding of ADP products in support of client needs
Provide consultation and help answer non-technical questions supporting less-experienced specialists on the team
Mentor and lead less-experienced specialists on the team
Learn and navigate ADP systems in order to resolve issue
3+ years of previous experience
Ability to troubleshoot and resolve customer complaints
Ability to demonstrate learning agility
Ability to learn and apply basic concepts in new situations
Organizational skills including the ability to multi-task, set priorities, and follow up in a
Timely manner
Ability to collaborate and work in a team environment as well as work independently and make sound decisions

Enrollment Specialist Resume Examples & Samples

Excellent interpersonal, verbal and written communication skills
Practical and dextrous
Can work effectively under pressure

Enrollment Specialist Resume Examples & Samples

Complies with all guidelines established by the Centers for Medicare and Medicaid (CMS) and guidelines set forth by other regulatory agencies, where applicable, and defined in the Universal American Corporate and department policies
Creative thinking skills with the ability to ask the needed bigger-picture questions that lead to process and team improvements
Time management skills with the ability to prioritize and schedule daily activities for the most efficient use of time
Problem solving skills with the ability to look for root causes and implementable, workable solutions
One year of recent/relevant experience required
Personal computer experience should include working with Microsoft Word, Excel, PowerPoint, Access, and Outlook at the intermediate level at minimum

Claims Enrollment Specialist Resume Examples & Samples

Serve as liaison between Practice Administrators, Office Managers and/or Billing Managers and insurance plans
Investigate, research, track, resolve and communicate any claims issues related to payment and contractual rates
Create customized fee schedules for Providers
Provide expertise / claims support to all stakeholders
Report trends of payer behavior
Collaborate with Provider Relations Representatives
Responds to requests for information and telephone inquiries from Providers and insurance carriers, in a courteous manner
Uses problem solving skills and planning abilities to diagnose and solve root process, payer and communicate system issues impacting revenue cycle
Stay informed on product information, changes in Medicare/Payor procedures and updates in policies
Contribute beyond fundamental responsibilities to support company growth and department development
Adds value and positive contributions towards the company and department culture
Maintain a climate of teamwork and collaborative problem solving
Performs other related duties as requested
Minimum High school diploma, associate's degree preferred
Minimum two year experience in the healthcare industry / customer service/ medical claims
Knowledge of physician office operations and the effect of managed care on a physician's practice
Knowledge of health care claims and health insurance industry
Knowledge of insurance company and medical service provider vocabulary, comprehending EOB's
Knowledge of ICD10 and CPT codes
Knowledge of claims processing and appeals procedures
Exceptional written and verbal communication skills, problem solving, time management skills
Advanced Excel skills
Demonstrated customer relations' skills to interact with physicians, and their office staffs to maintain high satisfaction
Ability to interact effectively with unhappy or dissatisfied customers/constituents
Proven ability to manage multiple assignments simultaneously
Ability to navigate health plan websites
Ability to analyze data and identify trends/consistencies
Ability to communicate effectively with insurance carriers, Providers and co-workers

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