CareOregon
Driven by our purpose
Our mission is to inspire and partner to create quality and equity in individual and community health. Our vision is healthy communities for all individuals, regardless of income or social factors.
Enrollment Specialist II
Essential Responsibilities
Technical Perform eligibility and enrollment functions including reconciliation of member enrollment and demographic information. Utilize private health data using multiple systems. Resolve discrepancies between enrollment and eligibility systems. Process incoming Medicare and/or Medicaid enrollments according to applicable state, federal, and internal CareOregon guidelines. Investigate other health insurance coverage status to assist with coordination of benefits. Ensure compliance with timely processing of eligibility, enrollment records, and/or member notification. Identify and escalate complex issues related to member access to care or compliance. Determine order of primacy when coordinating between more than two payers. Process incoming Medicare member Disenrollment and Cancellation transactions from CMS. Customer Service
Assist internal and external business partners, sales agents, and members regarding enrollment related inquiries such as benefit levels, eligibility status, sales support, grievances, and audits and appeals. Work collaboratively with internal and external business partners to ensure effective customer service and resolve enrollment related inquiries. Use online call tracking system to document all activities from any mode of communication from members, providers, and other customers. Maintain confidentiality for all customers. Treat all customers with honesty, courtesy, dignity, and respect. Outbound Calls
Conduct outbound calls to Medicaid and/or Medicare members, to assist with eligibility and enrollment. Conduct outbound calls to external business partners for eligibility verification and enrollment inquiries. Organizational Responsibilities
Perform work in alignment with the organization's mission, vision, and values. Support the organization's commitment to equity, diversity, and inclusion by fostering a culture of open mindedness, cultural awareness, compassion, and respect for all individuals. Strive to meet annual business goals in support of the organization's strategic goals. Adhere to the organization's policies, procedures, and other relevant compliance needs. Perform other duties as needed. Experience and/or Education
Required
Minimum 2 years' experience in healthcare or insurance in customer service, enrollment, billing, or related area Preferred
Experience with Medicare and/or Medicaid enrollment Experience working with CMS and/or OHA Knowledge, Skills and Abilities Required
Knowledge
Intermediate understanding of the concepts of managed care Skills and Abilities
Intermediate ability to apply Oregon Administrative Rules (OARs), federal laws and other regulatory requirements that relate to Medicaid/Medicare and the medical health insurance industry Strong skills in Microsoft Windows, Word, Excel, and Outlook Demonstrated ability to contribute to quality and productivity improvement efforts Demonstrated ability to participate fully in department meetings and contribute to decisions Demonstrated ability to work in a fast-paced environment and manage multiple tasks Intermediate research, analytical and problem-solving skills Demonstrated ability to adhere to a set schedule and sustain excellent attendance Demonstrated ability to learn and apply basic knowledge, including the completion requirements for CMS systems certifications and re-certifications (HPMS) Strong customer service skills, including the ability to interact professionally, patiently, and courteously over the phone Strong written, oral and active-listening communication skills Ability to articulate moderately complex issues in an easy-to-understand manner Demonstrated ability to provide clear and concise information and directions and follow instructions Ability to work effectively with diverse individuals and groups Ability to learn, focus, understand, and evaluate information and determine appropriate actions Ability to accept direction and feedback, as well as tolerate and manage stress Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day Ability to hear and speak clearly for at least 3-6 hours/day
Working Conditions
Work Environment(s): ☒ Indoor/Office ☐ Community ☐ Facilities/Security ☐ Outdoor Exposure
Member/Patient Facing: ☒ No ☐ Telephonic ☐ In Person
Hazards: May include, but not limited to, physical, ergonomic, and biological hazards.
Equipment: General office equipment.
Travel: May include occasional required or optional travel outside of the workplace; the employee's personal vehicle, local transit or other means of transportation may be used.
Estimated Hiring Range: $22.82 - $27.89
We offer a strong Total Rewards Program.
This includes competitive pay, bonus opportunity, and a comprehensive benefits package. Eligibility for bonuses and benefits is dependent on factors such as the position type and the number of scheduled weekly hours. Benefits-eligible employees qualify for benefits beginning on the first of the month on or after their start date. CareOregon offers medical, dental, vision, life, AD&D, and disability insurance, as well as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.). We also offer a strong retirement plan with employer contributions. Benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state. Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility. Non-benefits eligible employees can enjoy 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks. Please contact your recruiter for more information.
We are an equal opportunity employer
CareOregon is an equal opportunity employer. The organization selects the best individual for the job based upon job related qualifications, regardless of race, color, religion, sexual orientation, national origin, gender, gender identity, gender expression, genetic information, age, veteran status, ancestry, marital status or disability. The organization will make a reasonable accommodation to known physical or mental limitations of a qualified applicant or employee with a disability unless the accommodation will impose an undue hardship on the operation of our organization.
Our mission is to inspire and partner to create quality and equity in individual and community health. Our vision is healthy communities for all individuals, regardless of income or social factors.
Enrollment Specialist II
Essential Responsibilities
Technical Perform eligibility and enrollment functions including reconciliation of member enrollment and demographic information. Utilize private health data using multiple systems. Resolve discrepancies between enrollment and eligibility systems. Process incoming Medicare and/or Medicaid enrollments according to applicable state, federal, and internal CareOregon guidelines. Investigate other health insurance coverage status to assist with coordination of benefits. Ensure compliance with timely processing of eligibility, enrollment records, and/or member notification. Identify and escalate complex issues related to member access to care or compliance. Determine order of primacy when coordinating between more than two payers. Process incoming Medicare member Disenrollment and Cancellation transactions from CMS. Customer Service
Assist internal and external business partners, sales agents, and members regarding enrollment related inquiries such as benefit levels, eligibility status, sales support, grievances, and audits and appeals. Work collaboratively with internal and external business partners to ensure effective customer service and resolve enrollment related inquiries. Use online call tracking system to document all activities from any mode of communication from members, providers, and other customers. Maintain confidentiality for all customers. Treat all customers with honesty, courtesy, dignity, and respect. Outbound Calls
Conduct outbound calls to Medicaid and/or Medicare members, to assist with eligibility and enrollment. Conduct outbound calls to external business partners for eligibility verification and enrollment inquiries. Organizational Responsibilities
Perform work in alignment with the organization's mission, vision, and values. Support the organization's commitment to equity, diversity, and inclusion by fostering a culture of open mindedness, cultural awareness, compassion, and respect for all individuals. Strive to meet annual business goals in support of the organization's strategic goals. Adhere to the organization's policies, procedures, and other relevant compliance needs. Perform other duties as needed. Experience and/or Education
Required
Minimum 2 years' experience in healthcare or insurance in customer service, enrollment, billing, or related area Preferred
Experience with Medicare and/or Medicaid enrollment Experience working with CMS and/or OHA Knowledge, Skills and Abilities Required
Knowledge
Intermediate understanding of the concepts of managed care Skills and Abilities
Intermediate ability to apply Oregon Administrative Rules (OARs), federal laws and other regulatory requirements that relate to Medicaid/Medicare and the medical health insurance industry Strong skills in Microsoft Windows, Word, Excel, and Outlook Demonstrated ability to contribute to quality and productivity improvement efforts Demonstrated ability to participate fully in department meetings and contribute to decisions Demonstrated ability to work in a fast-paced environment and manage multiple tasks Intermediate research, analytical and problem-solving skills Demonstrated ability to adhere to a set schedule and sustain excellent attendance Demonstrated ability to learn and apply basic knowledge, including the completion requirements for CMS systems certifications and re-certifications (HPMS) Strong customer service skills, including the ability to interact professionally, patiently, and courteously over the phone Strong written, oral and active-listening communication skills Ability to articulate moderately complex issues in an easy-to-understand manner Demonstrated ability to provide clear and concise information and directions and follow instructions Ability to work effectively with diverse individuals and groups Ability to learn, focus, understand, and evaluate information and determine appropriate actions Ability to accept direction and feedback, as well as tolerate and manage stress Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day Ability to hear and speak clearly for at least 3-6 hours/day
Working Conditions
Work Environment(s): ☒ Indoor/Office ☐ Community ☐ Facilities/Security ☐ Outdoor Exposure
Member/Patient Facing: ☒ No ☐ Telephonic ☐ In Person
Hazards: May include, but not limited to, physical, ergonomic, and biological hazards.
Equipment: General office equipment.
Travel: May include occasional required or optional travel outside of the workplace; the employee's personal vehicle, local transit or other means of transportation may be used.
Estimated Hiring Range: $22.82 - $27.89
We offer a strong Total Rewards Program.
This includes competitive pay, bonus opportunity, and a comprehensive benefits package. Eligibility for bonuses and benefits is dependent on factors such as the position type and the number of scheduled weekly hours. Benefits-eligible employees qualify for benefits beginning on the first of the month on or after their start date. CareOregon offers medical, dental, vision, life, AD&D, and disability insurance, as well as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.). We also offer a strong retirement plan with employer contributions. Benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state. Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility. Non-benefits eligible employees can enjoy 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks. Please contact your recruiter for more information.
We are an equal opportunity employer
CareOregon is an equal opportunity employer. The organization selects the best individual for the job based upon job related qualifications, regardless of race, color, religion, sexual orientation, national origin, gender, gender identity, gender expression, genetic information, age, veteran status, ancestry, marital status or disability. The organization will make a reasonable accommodation to known physical or mental limitations of a qualified applicant or employee with a disability unless the accommodation will impose an undue hardship on the operation of our organization.