Enrollment and Eligibility Analyst
TPIS-Temporary Professional Integrated Services
full-time
Posted on:
Location Type: Office
Location: San Juan • Puerto Rico
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Salary
💰 $13 per hour
Job Level
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 & Tools
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