Current jobs related to Medicare Enrollment Specialist - Moultrie - PruittHealth

JOB OBJECTIVE:

The Enrollment Specialist role at PruittHealth Premier is designed to function as a certified insurance representative, tasked with elucidating Plan advantages and addressing inquiries from prospective members or their designated representatives.

This position is pivotal in pinpointing potential membership opportunities and facilitating prompt engagement to aid in the enrollment process for the health plan.

Moreover, the specialist will deliver continuous marketing assistance to our affiliated skilled nursing facility personnel, organize facility and community outreach events, and provide educational resources to both our skilled nursing facilities and local communities to bolster our I-SNP and D-SNP initiatives as required.

PRIMARY DUTIES:

• Act as a certified insurance representative to clarify Plan advantages and respond to inquiries from potential members or their representatives.
• Collaborate with sales leadership to efficiently enroll residents into institutional special needs plans (ISNPs) and dual special needs plans (DSNPs).
• Work closely with sales administration management for necessary enrollment administrative support.
• Effectively employ sales closing techniques to drive enrollments, maintaining a robust closing rate.
• Adhere to established sales protocols and standard operating procedures, effectively utilizing and updating company systems and databases, including those for entering referrals and enrollments.
• Demonstrate the ability to learn and implement Centers for Medicare & Medicaid Services rules and regulations.
• Engage with potential members or their representatives to ensure all questions are addressed, existing benefits are compared to plan advantages, and serve as a point of contact for assistance during the enrollment journey.
• Participate in facility events for plan marketing in compliance with CMS guidelines.
• Provide monthly updates of upcoming enrollees to facility and agency contacts prior to month-end.
• Ensure all member interactions comply with CMS regulations.
• Conduct monthly facility audits in accordance with the provided checklist.
• The Enrollment Specialist will oversee a designated geographic area of participating nursing facilities and counties for D-SNP marketing and enrollment as applicable.
• Maintain an active license to sell life and health insurance and AHIP certification to uphold employment in this capacity.

SKILLS AND QUALIFICATIONS:

• Proficient technological skills to engage with potential members and families interested in enrollment.
• Ability to uphold health insurance licensure and Continuing Education Requirements as mandated by the licensing state.
• Comfortable and patient in communicating through web-based video platforms.
• Proactive self-starter capable of influencing others.
• Strong written and verbal communication skills with the ability to deliver impactful presentations.
• Demonstrated ability to work independently and efficiently.
• Proficient computer skills and familiarity with Microsoft Office Suite products.
• Willingness to travel to local meeting venues as necessary.
• Significant sales experience.
• Knowledge of Medicare/Medicaid and/or nursing community dynamics.
• Exhibit compliance with CMS regulations regarding Medicare Advantage Plans and PruittHealth Code of Conduct.
• Demonstrate exceptional interpersonal skills with the ability to work both independently and collaboratively.

Outstanding organizational abilities:
Excellent written and verbal communication skills with the capacity to distill complex issues into clear messages.

• Willingness and capability to travel to facilities within the assigned region; possess reliable transportation, a valid driver's license, a clean driving record, and proof of insurance.
• Have a suitable home workspace conducive to a productive office environment.
• Understand the PruittHealth Premier Plan benefits, policies, and procedures, articulating them effectively to providers, potential members, and key decision-makers.
• Complete annual Medicare Fraud, Waste, and Abuse Training and Model of Care Training.

Qualifications:

MINIMUM EDUCATION REQUIRED:

Bachelor's degree required.

MINIMUM EXPERIENCE REQUIRED:

2 years of health insurance sales experience preferred.

Strong communication and organizational skills are essential.

Ability to professionally present plan benefits and financial information.

MINIMUM LICENSURE/CERTIFICATION REQUIRED BY LAW:

Life & Health Insurance License.

ADDITIONAL QUALIFICATIONS: (Preferred qualifications)

• AHIP Certification and licensed to sell Life and Health insurance in required states to function as an enrollment agent if necessary. (Preferred to have this upon hire)

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