Candidates hired for remote positions must reside in Oregon, Washington, Utah, Idaho, Arizona, Nevada, Texas, Montana, or Wisconsin.

Job Summary

The Enrollment Specialist II is responsible for the proficient, timely, and accurate entry and maintenance of member eligibility and enrollment data; customer service; and coordination of benefits.  This is an intermediate level enrollment position.

Essential Responsibilities

Technical

• Perform eligibility and enrollment functions including reconciliation of member enrollment and demographic information.
• Utilize private health data using multiple systems.
• Resolve discrepancies between enrollment and eligibility systems.
• Process incoming Medicare and/or Medicaid enrollments according to applicable state, federal, and internal CareOregon guidelines.
• Investigate other health insurance coverage status to assist with coordination of benefits.
• Ensure compliance with timely processing of eligibility, enrollment records, and/or member notification.
• Identify and escalate complex issues related to member access to care or compliance.
• Determine order of primacy when coordinating between more than two payers.
• Process incoming Medicare member Disenrollment and Cancellation transactions from CMS.

Customer Service

• Assist internal and external business partners, sales agents, and members regarding enrollment related inquiries such as benefit levels, eligibility status, sales support, grievances, and audits and appeals.
• Work collaboratively with internal and external business partners to ensure effective customer service and resolve enrollment related inquiries.
• Use online call tracking system to document all activities from any mode of communication from members, providers, and other customers.
• Maintain confidentiality for all customers.
• Treat all customers with honesty, courtesy, dignity, and respect.

Outbound Calls

• Conduct outbound calls to Medicaid and/or Medicare members, to assist with eligibility and enrollment.
• Conduct outbound calls to external business partners for eligibility verification and enrollment inquiries.

Organizational Responsibilities

• Perform work in alignment with the organization’s mission, vision, and values.
• Support the organization’s commitment to equity, diversity, and inclusion by fostering a culture of open mindedness, cultural awareness, compassion, and respect for all individuals.
• Strive to meet annual business goals in support of the organization’s strategic goals.
• Adhere to the organization’s policies, procedures, and other relevant compliance needs.
• Perform other duties as needed.

Experience and/or Education

Required

• Minimum 2 years’ experience in healthcare or insurance in customer service, enrollment, billing, or related area

Preferred

• Experience with Medicare and/or Medicaid enrollment
• Experience working with CMS and/or OHA

• Experience with Insurance verification to include Medicare and Medicaid. 

    

Knowledge, Skills and Abilities Required

Knowledge

• Intermediate understanding of the concepts of managed care

Skills and Abilities

• Intermediate ability to apply Oregon Administrative Rules (OARs), federal laws and other regulatory requirements that relate to Medicaid/Medicare and the medical health insurance industry
• Strong skills in Microsoft Windows, Word, Excel, and Outlook
• Demonstrated ability to contribute to quality and productivity improvement efforts
• Demonstrated ability to participate fully in department meetings and contribute to decisions
• Demonstrated ability to work in a fast-paced environment and manage multiple tasks
• Intermediate research, analytical and problem-solving skills
• Demonstrated ability to adhere to a set schedule and sustain excellent attendance
• Demonstrated ability to learn and apply basic knowledge, including the completion requirements for CMS systems certifications and re-certifications (HPMS)
• Strong customer service skills, including the ability to interact professionally, patiently, and courteously over the phone
• Strong written, oral and active-listening communication skills
• Ability to articulate moderately complex issues in an easy-to-understand manner
• Demonstrated ability to provide clear and concise information and directions and follow instructions

• Ability to work effectively with diverse individuals and groups

• Ability to learn, focus, understand, and evaluate information and determine appropriate actions
• Ability to accept direction and feedback, as well as tolerate and manage stress
• Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day
• Ability to hear and speak clearly for at least 3-6 hours/day

Working Conditions

Work Environment(s):        ☒ Indoor/Office    ☐ Community      ☐ Facilities/Security     ☐ Outdoor Exposure

Member/Patient Facing:    ☒ No                          ☐ Telephonic        ☐ In Person

Hazards:  May include, but not limited to, physical, ergonomic, and biological hazards.

Equipment:  General office equipment.

Travel: May include occasional required or optional travel outside of the workplace; the employee’s personal vehicle, local transit or other means of transportation may be used.

#MULTI

Candidates of color are strongly encouraged to apply. CareOregon is committed to building a linguistically and culturally diverse and inclusive work environment.

Veterans are strongly encouraged to apply.

We are an equal opportunity employer. CareOregon considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, or veteran status.

Visa sponsorship is not available at this time.