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Medicare Member Enrollment Rep II
2 months ago
Description:
This is a remote role that can be done in most US states.
As a not-for-profit organization, Mass General Brigham is committed to supporting patient care, research, teaching, and service to the community by leading innovation across our system. Founded by Brigham and Womens Hospital and Massachusetts General Hospital, Mass General Brigham supports a complete continuum of care including community and specialty hospitals, a managed care organization, a physician network, community health centers, home care and other health-related entities. Several of our hospitals are teaching affiliates of Harvard Medical School, and our system is a national leader in biomedical research.
Were focused on a people-first culture for our systems patients and our professional family. Thats why we provide our employees with more ways to achieve their potential. Mass General Brigham is committed to aligning our employees personal aspirations with projects that match their capabilities and creating a culture that empowers our managers to become trusted mentors. We support each member of our team to own their personal developmentand we recognize success at every step.
Our employees use the Mass General Brigham values to govern decisions, actions, and behaviors. These values guide how we get our work done: Patients, Affordability, Accountability & Service Commitment, Decisiveness, Innovation & Thoughtful Risk; and how we treat each other: Diversity & Inclusion, Integrity & Respect, Learning, Continuous Improvement & Personal Growth, Teamwork & Collaboration.
As part of the Member Enrollment Team, you will be responsible for the enrollment and billing tasks for Medicare members including the entry of information into Mass General Brigham Health Plan enrollment systems and working with reports to resolve discrepancies. Also, managing outgoing and incoming extracts, including the ID cards for Medicare members, to ensure that accurate data is sent. This is a brand new and highly visible line of business, so accuracy is critical. Depending on work volume fluctuations, especially outside of Medicare Open Enrollment, you will cross train on and assist with Commercial and MassHealth enrollment related tasks.
As an Enrollment Representative you will have many interactions with internal clients, such as IT, Customer Services, Sales, Claims, Product and Finance, therefore excellent customer service skills are essential. Other duties include, assisting with monthly reconciliation, assisting on special projects as needed, and researching discrepancy reports. In addition, you will also help with paperless processes, other general administrative duties and special projects as assigned.
Essential Functions:
- Deal with complex enrollment issues from either internal representatives or sales staff. These issues could vary from pharmacy, eligibility, billing, and group set up.
- Researching and resolving Billing issues.
- Responsible for triggering letters to members.
- Responsible for accurate data for all members.
- Overseeing in the absence of direct supervisor.
- Responsible for navigating various systems (QNXT, EAM, MERP, etc) in order to resolve member issues.
- Responsible for understanding the distinction between different lines of business (Medicare, Commercial, MassHealth).
- Meet or exceed daily productivity goals.
- Meet or exceed monthly QC goal.
- Act as back-up to specific job functions in the department such as, but not limited to (troubleshooter reports. etc.).
- Participating in all team meetings and facilitating in the absence of Supervisor.
- Assisting less experienced staff with more complex issues. (All of the reps have their strengths and help cross train each other).
- Anticipates and meets, or exceeds, internal and/or external customer expectations and requirements; establishes and maintains effective relationships with customers and gains their trust and respect.
- Take initiative to come up with solutions to issues and enhancements to processes
- Working with direct supervisor, ensure documentation is up-to-date and saved in a shared location for reference
- Sense of urgency and strong communication skills.
- Strong data entry skills and data interpretation knowledge.
- Ability to read reports and take note of trends.
- Open collaboration with internal and external management.
- Train other staff as needed.
- Lead/represent the team on special projects.
- Attend meetings as needed.
- Hold self and others accountable to meet commitments.
- Ensure diversity, equity, and inclusion are integrated as a guiding principle.
- Persist in accomplishing objectives to consistently achieve results despite any obstacles and setbacks that arise.
- Build strong relationships and infrastructures that designate Mass General Brigham Health Plan as a people-first organization.
- Other duties as assigned with or without accommodation.
Qualifications:
- High School diploma required or the equivalent combination of training and experience, plus 3 years of related health plan experience, 1-3 years in a customer service environment preferred.
- Enrollment experience with a Medicare Advantage product is highly preferred
- Excel/reporting background
- College degree preferred
- Demonstrate Mass General Brigham Health Plan's core brand principles of always listening, challenging conventions, and providing value.
- Bring fresh ideas forward by listening to and working with employees and the people we serve.
- Respect the talent and unique contributions of every individual and treat all people in a fair and equitable manner.
- Strong, demonstrated track record of an ability to execute on time, on budget, and on scope.
- Strong aptitude for technology-based solutions.
- Ability to inject energy, when and where its needed.
- Current in healthcare trends.
- Demonstrated forward, visionary thinking; ability to see what is and envision what could be.
- Ability to develop, introduce, defend, and gain support for a new ideas and approaches.
- Excellent leadership skills and leadership track record.
- Ability to translate and communicate complex topics in a variety of forums, tailoring communications to effectively fit and influence the targeted audience, strong executive presence, presentation, and communication skills. Strong verbal, active listening, and written communication skills required.
- Ability to view the long-range trends and cycles of the business and industry and see the big picture.
- Ability to apply a variety of strategic frameworks to analyze problems and to guide and develop solutions.
- Ability to challenge the status quo and drive innovative thinking and the capability to successfully implement strategy.
- Excellent interpersonal skills, including the ability to influence others at all levels of an organization.
- Strong EQ; exercises self-awareness; monitors impact on others; is receptive to and seeks out feedback; uses self-discipline to adjust to feedback.
- Unquestionable integrity.
Mass General Brigham is an Equal Opportunity Employer. By embracing diverse skills, perspectives, and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under the law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, perform essential job functions, and receive other benefits and privileges of employment.
Primary Location MA-Somerville-MGB Health Plan at Assembly Row
Work Locations MGB Health Plan at Assembly Row 399 Revolution Drive Somerville 02145
Admin/Clerical/CustService-Other
Job Admin/Clerical/CustService-Other
Organization Mass General Brigham Health Plan
Schedule Full-time
Standard Hours 40
Shift Day Job
Employee Regular
Job Posting Sep 3, 2024
