Supervisor, Enrollment Medicare
Cambridge MA 02141 58 Charles Street
Job DescriptionThis position is responsible for overseeing the enrollment and disenrollment of eligible Medicare Part D enrollees. This position is also responsible for ensuring Medicare enrollment and eligibility services are compliant with all CMS regulations while maintaining a high level of client and customer service. This role will work closely with internal and external stakeholders to ensure that business requirements are documented, communicated and meet customer needs.
- Leads, coordinates, monitors and reports all Medicare enrollment and eligibility activities in accordance with the laws, regulations and policies that govern Medicare Part D.
- Ability to read, interpret, and operationalize Medicare Part D guidance and understand how various aspects of the guidance is interdependent and related.
- Coordinates and monitors the processing of incoming enrollment response files such as the Medicare TRR file, and takes appropriate steps on actionable items to ensure accurate member enrollment and eligibility according to the Medicare MARx system. Understands enrollment guidelines and policies needed for entry of eligibility information into the database system.
- Verifies group and/or individual eligibility data received is in accordance with the current contract.
- Responsible for the training and development of lower level staff and maintaining a teamwork environment.
- Assists in a first line directing capacity, administering department policies, procedures, functions, and activities of the Med D enrollment team including coordinating and managing the team workload.
- Conducts hiring, performance appraisals, career counseling and related tasks for direct reports.
- Interacts with our clients (Human Resources, IT, third party enrollment vendor, etc.), government agencies, and/or state departments to resolve incorrect or missing information needed to enroll or make changes to a member's eligibility.
- Provides accuracy in maintaining company standards for entering eligibility.
- Researches and resolves incoming inquiries (phone calls, emails, web messages, etc.) from both internal and external customers while maintaining company standards for professionalism and customer service.
- Interfaces with several departments to ensure compliance with company policies and procedures as well as Federal regulations.
- Ensures the correctness of member files and understands the impacts of revenue collected and benefits paid.
- Understands and applies all COBRA, TCC, and HIPAA laws, as applicable, ensuring that they are correct and consistent with state and federal policies.
- Collaborates with multiple departments to ensure all enrollment policies and procedures are updated regularly and are operationally sound to meet the Medicare Part D regulations.
- Ensures that Medicare Enrollment is monitored and tasks are completed on a daily basis (or as mandated by CMS).
- Ensures mandatory reports are submitted to CMS accurately and timely.
- Acts as a liaison with client and/or PBM for all enrollment related operations and oversight.
- Participates in the growth strategy of the organization as requested by senior leadership.
- May present reports and other enrollment related information to internal/external stakeholders.
- Work with clients as necessary for new group implementation and training.
- Manage and complete assigned work plan objectives and projects on a timely basis.
- Define goals for Medicare eligibility standards.
- Utilize defined protocols and tools established for validating and evaluating performance objectives.
- Exercise substantial independent decision-making and accountability to ensure compliance.
- Resolve escalated issues from the operational areas and FDRs related to Medicare Part D.
- Ability to interact with clients and FDRs as needed.
- Work with Compliance Officer and other Medicare supervisors and managers to complete all necessary eligibility auditing and monitoring, including the Annual Readiness Assessment, CMS audits, internal audits, and client audits.
General Job Information
TitleSupervisor, Enrollment Medicare
Job FamilyPharmacy Group
CountryUnited States of America
FLSA StatusUnited States of America (Exempt)
Recruiting Start Date3/26/2019
Date Requisition Created3/26/2019
License and Certifications - Required
License and Certifications - Preferred
Other Job Requirements
- Prior experience working with Medicare enrollment and eligibility.
- Proven experience evaluating processes and making process improvements.
- Medicare Part D operations experience.
- Minimum 3 years of relevant experience (PBM, HealthCare, Client Implementations, Account Management).
- Excellent interpersonal skills necessary to develop and maintain outstanding relationships.
- Ability to manage a high volume of projects effectively.
- Demonstrated Project Management, issue resolution, leadership, and multi-tasking skills.
- Strong verbal and written communication skills.
- Must be able to reach across departmental boundaries to resolve problems and to train/share knowledge of complex processes.
- Strong, well-developed computer skills i.e.: MS Office suite, project management programs.
- Extensive knowledge of and experience with the Health Insurance and Portability and Accountability Act (HIPAA).
Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.
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