CareFirst Careers

Enrollment Analyst I

Resp & Qualifications

PURPOSE: 

The Enrollment Analyst supports the Enrollment Manager in the investigation and resolution of complex enrollment issues, in accordance to CareFirst CHP-DC contract guidelines.  This role ensures that these issues are resolved within the mandatory guidelines as established by state and federal regulatory agencies and in accordance with CareFirst CHP-DC policy.

 

PRINCIPAL ACCOUNTABILITIES:

 

Under the direct supervision of the Enrollment Manager, the Enrollment Analyst is responsible to:

 

  • Facilitate and/or assist with the automated enrollment process , including automated monthly loads, member reconciliation, member notifications, including newborn enrollments, presumptive newborn dis-enrollments and long term care dis-enrollment requests.
  • Identify any abnormalities in the enrollment process.
  • Review and reconcile daily, weekly reconciliation reports.
  • Perform and/or assist with the PCP changes due to Provider Terminations and maximum Provider Panel Closings.
  • Prepare documentation for the District Health Care Finance Office to include Out of State Report, Incarcerated Members Report, Long Term Care dis-enrollment request.
  • QA all submissions to DHCF.
  • Validate and update District TPL/COB in MHC.
  • Assist Enrollment Manager with review of Enrollment desk level procedures/standard operating procedures and recommend updates to align with current processes and procedures.

 

SUPERVISORY RESPONSIBILITY:  None

 

NECESSARY QUALIFICATIONS:

 

Required Experience/Skills/Abilities:  

  • A minimum of one (1) year of membership enrollment experience
  • Experience working with health care benefits or DC Medicaid
  • Principles and practices of the managed health care systems, and medical administration and NCQA Accreditation standards.
  • Exercise exceptional judgment in decision-making, meet deadlines, and to work independently and with flexibility
  • Managed Care experience preferred
  • Problem solving skills
  • MHC preferred
  • Proficient in Microsoft Office tools (Excel, Word, Outlook, PowerPoint)

 

Preferred:

Degree or some college level courses; or administrative certifications.

 

Note:  The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

 

PHYSICAL DEMANDS:

 

The physical demands described here are representative of those that must be met by an employee to perform the essential duties and responsibilities of the position successfully.  Requirements may be modified to accommodate individuals with disabilities.

 

The employee is primarily seated while performing the duties of the position.  Occasional walking or standing is required.  The hands are regularly used to write, type, key and handle or feel small controls and objects.  The employee must frequently talk and hear.  Weights of up to 25 pounds are occasionally lifted.

 

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