Medicare Advantage Enrollment Expertise

Will this position be required to work onsite for any reason at any time? Yes, on Tuesdays

Top 3 Required Skills/Experience

• CMS Knowledge
• Data Reconciliation and file management
• Good Communication

Required Skills/Experience The rest of the required skills/experience. Include:
Medicare Advantage Enrollment Expertise:

• Minimum 2-4 years of direct experience with Medicare Advantage Enrollment processes
• Experience with CMS MAPD, MA and PDP standalone enrollment/disenrollment regulations, enrollment mechanisms, Late Enrollment Penalty (LEP) and Low-Income Subsidy (LIS), Plan Communication User Guide

Data Reconciliation and File Management:

• Experience with monthly/weekly membership reconciliation
• Experience with monthly CMS membership reconciliation (MARx, TRR).
• Ability to analyze discrepancies, manage large datasets and track resolution through internal reporting tools.
• Knowledge of CMS thresholds and compliance timelines for discrepancy resolution.
• Understanding of required documentation and timelines for retroactive processing and case development.

Operational Process Improvement:

• Ability to identify operational gaps, define root causes, and implement process improvements

Regulatory Compliance and Audit Support:

• Experience supporting internal and CMS program audits and Compliance reporting.

Technical and Reporting Skills:

• Intermediate experience of Microsoft Programs with Excel (Pivot tables), Word, Outlook, OneNote

Communication and Knowledge Dissemination:

• Effective written and verbal communication skills