Enrollment Specialist Resume Samples

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TD
T Daniel
Terrill
Daniel
995 Agustina Isle
New York
NY
+1 (555) 862 5598
995 Agustina Isle
New York
NY
Phone
p +1 (555) 862 5598
Experience Experience
11/2015 present
Detroit, MI
Senior Enrollment Specialist
Detroit, MI
Senior Enrollment Specialist
11/2015 present
Detroit, MI
Senior Enrollment Specialist
11/2015 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
06/2009 10/2015
Detroit, MI
Claims Enrollment Specialist
Detroit, MI
Claims Enrollment Specialist
06/2009 10/2015
Detroit, MI
Claims Enrollment Specialist
06/2009 10/2015
  • 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
04/2004 05/2009
Detroit, MI
Enrollment Specialist
Detroit, MI
Enrollment Specialist
04/2004 05/2009
Detroit, MI
Enrollment Specialist
04/2004 05/2009
  • 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
Education Education
Bachelor’s Degree in Marketing
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

1

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
2

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 ****
3

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
4

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
5

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
6

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
7

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
8

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
9

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
10

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
11

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
12

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
13

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
14

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
15

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
16

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
17

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
18

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
19

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
20

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
21

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
22

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
23

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
24

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
25

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
26

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
27

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
28

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
29

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
30

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
31

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
32

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
33

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
34

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
35

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
36

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
37

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
38

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
39

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
40

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
41

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
42

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
43

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
44

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
45

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
46

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
47

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
48

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
49

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
50

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
51

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
52

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
53

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
54

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
55

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
56

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
57

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
58

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
59

Enrollment Specialist Resume Examples & Samples

  • Excellent interpersonal, verbal and written communication skills
  • Practical and dextrous
  • Can work effectively under pressure
60

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
61

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