Steward Health Care Network (SHCN) takes pride in its community-based care model, which drives value-added tools and services to our communities, patients, physicians, and hospitals across the continuum of care. In addition, Steward Health Care Network promotes care coordination and collaboration within the network in order to provide high-quality, efficient care to patients. With Steward in the community, all residents can be sure that there is a world class doctor close to where they live.
The network is also responsible for the implementation and execution of our managed care contracts, medical management services, quality improvement programs, data analysis, and information services.
The Enrollment Coordinator processes enrollment applications with quality and efficiency and assists in all aspects of the enrollment/disenrollment process. This is done by following reporting requirements and ensuring all transactions are in accordance with Centers for Medicare and Medicaid Service (CMS) regulations.
- Process new member enrollments including verification of eligibility for Medicare and Medicaid
- Maintain files of every enrollment application received by Steward Health Choice Generations along with copies of enrollment/disenrollment communications
- Submit enrollment and disenrollment’s transactions to CMS timely and accurately
- Create and mail member enrollment/disenrollment communications
- Comply with CMS reporting requirements and standards
- Retrieve reports/files from CMS and reconcile the data received from CMS
- Identify and resolve enrollment issues
- Implement process updates/changes appropriately
- Monitor and maintain out of service area/Loss of Special need status membership to determine when involuntary disenrollment’s should be processed
- Answer enrollment inquiries from internal/external Brokers via assistance line
Education / Experience / Other Requirements
- High School Diploma or equivalent GED (required)
- Associates Degree (preferred)
Years of Experience:
- Minimum: 2 years customer service experience (Contact Center experience preferred)
- Preferred: 2 years customer service experience in the area of Medicare Advantage Plans
- Knowledge of CMS regulations and guidelines helpful
- Knowledge of medical terminology helpful
- Knowledge of Microsoft office; Word, Excel
- Strong ability to logically resolve issues and interpret findings
- Work cooperatively, positively, and collaboratively in an interdisciplinary team
- Ability to multi-task and prioritize work tasks to adhere to deadlines and identified time frames
Equal Opportunity Employer Minorities/Women/Veterans/Disabled
Steward Health Care Network is taking additional, necessary preparations to ensure patients can receive compassionate care in a safe, carefully managed environment – with confidence and without fear.
Our Safe and Ready program consists of a rigorous [three-point] standard ensuring patient safety, confidence and convenience:
- Any COVID-19 related care takes place in designated areas away from other patients and their families.
- A stringent cleaning policy has been implemented throughout our facilities.
- A strictly controlled visitor and masking policy is required for patient and colleague safety.
You can rest assured that we have made the necessary preparations to provide care in a safe, controlled and professional way.