Enrollment and Eligibility Analyst
TPIS-Temporary Professional Integrated Services
full-time
Posted on:
Location Type: Office
Location: San Juan • 🇵🇷 Puerto Rico
Visit company websiteSalary
💰 $13 per hour
Job Level
Junior
About the role
- Analyzing and determining the prospect eligible for the Medicare Advantage Programs.
- Receives and processes applications for Enrollment, unsubscribe, Cancellation, and Product Changes received in the Eligibility Unit within 7 days.
- Evaluates, analyze, and determines that enrollment documents submitted by Sales Representatives and Independent Agents comply with established state, federal, and business regulations.
- Determines prospect eligibility in CMS and Ases systems, performs data entry or correction in Voyager and On Base systems, determines applicable eligibility period, makes notes, and sends appropriate letters.
- Identifies cases that cannot be processed due to missing information, which initiates the returns process.
- Generates weekly reports of all cases in the system awaiting information, ensuring final determination does not exceed the applicable 7 or 21 days, to comply with current federal regulations.
- Works the weekly audit report to ensure that no case has been processed or denied without a notification letter.
- Complies with the OFA (Out of Area) unsubscribe process, which should be done within the first 3 days of each month.
- Responsible for receiving, punching, classifying, and digitizing all internal and external correspondence received in the Affiliations Unit.
Requirements
- 60 university credits or equivalent to two (2) years of studies or associate degree in Business Administration or Health Services Billing preferably.
- Minimum of one (1) year of experience in group and individual enrollment processes, preferably in the Health Insurance Industry.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
data entrydata analysisenrollment processingdocument evaluationreport generationcompliance analysiseligibility determination
Soft skills
attention to detailorganizational skillscommunication skills
Certifications
associate degree in Business Administrationassociate degree in Health Services Billing