Centers Plan for Healthy Living's goal is to create the ultimate healthcare experience that provides our members, their families, healthcare decision makers, and general caregivers with the guidance and plans they need for healthy living.

JOB SUMMARY:
Responsible for the reviewing, preparing and submitting enrollment applications, adhering to CMS procedures and tracking outcomes for the Medicare plans. Must be familiar with CMS guidelines surrounding enrollment procedures, and possess knowledge and understanding of the regulatory environment under which such plans operate.

PRIMARY RESPONSIBILITIES:

• Review, prepare, and submit enrollments in CMS database in a timely manner
• Complete assigned tasks accurately following all workflows
• Maintains departmental records and files, and submits reports as needed
• Professional and timely intra and inter-departmental communication
• Maintains contacts with outside vendors and other entities as needed
• Up-to-date knowledge of eligibility criteria and benefits of plan
• Complies with all CPHL standards for documentation
• Maintains member confidentiality and compliance with HIPAA requirements
• Participates in quality improvement initiatives
• Identify and escalate issues accordingly
• Performs all other duties assigned

EDUCATION AND EXPERIENCE:
Education:
High School Diploma or equivalency required; Bachelor Degree in Healthcare or related field preferred

Experience:
Knowledge of Medicare/Medicaid programs preferred

Specific Technical Skills:
Proficiency with Microsoft Office (Excel, Outlook and Word)

Certification/Licensure:
None required

SCOPE INFORMATION
# Direct Reports: N/A

PHYSICAL REQUIREMENTS:
The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
The above statements are intended to describe the general nature and level of work performed by individuals assigned to the job classification. They should not be construed as an exhaustive list of all responsibilities, duties and skills required.

Centers Plan For Healthy Living is committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our employees and our business. We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law and will not be denied employment.


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