Enrollment Analyst – ACA Enrollment
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Job Description
Enrollment Analyst processing ACA/Marketplace transactions for Peak Health’s health plan. Reconciling CMS records, validating eligibility, and supporting compliant enrollment operations.
Responsibilities:
- Review, execute, and oversee member enrollment application information processing for Peak Health’s Plan Suite
- Manage weekly enrollment files and daily ACA/Marketplace enrollment transactions
- Process new enrollments, maintenance transactions, cancellations, terminations, reinstatements, plan changes, and SEP requests
- Reconcile membership, coverage, Marketplace, CMS, and issuer records; resolve discrepancies, errors, rejects, and exceptions
- Maintain member enrollment records, APTC/CSR information, databases, and work queues
- Validate applicant eligibility, household information, coverage effective dates, enrollment status, and supporting documentation
- Process and research SNP, ACA/FFM, Medicare, and ASO enrollment applications and transactions
- Complete EDV monthly processes, REED submissions, CMS reconciliations, LEP data files, and MPWR files
- Monitor production and quality standards and conduct audits for regulatory compliance
- Respond to member inquiries regarding enrollment procedures, benefits, and eligibility
- Develop and deliver enrollment training for new hires and maintain job aids and standard operating procedures
- Participate in system testing, UAT, validation activities, Open Enrollment planning, and process improvement initiatives
- Analyze enrollment data, prepare management reports, identify trends and discrepancies, and recommend improvements
- Collaborate with underwriting, billing, customer service, Marketplace representatives, vendors, and other stakeholders
- Escalate issues appropriately and troubleshoot enrollment system problems
Requirements:
- High school diploma or equivalent
- Three years of experience working with medical or institutional data entry
- Three years of customer service experience
- Two years of Medicare eligibility and Medicare enrollment processing experience
- Preferred: three or more years of ACA/Marketplace enrollment processing experience
- Experience working with Federally Facilitated Marketplace (FFM) enrollment operations
- Familiarity with Health Insurance Marketplace eligibility and enrollment regulations
- Familiarity with Medicare elections, transaction codes, reconciliation operations, LEP management, CMS tools, MARx, EDVs, and REED submissions
- At least one year of system/user acceptance testing experience
- At least one year of experience developing and delivering trainings
- Previous experience in EMR systems
- Working knowledge of administrative and clerical procedures, word processing, and records management
- Ability to navigate multiple systems simultaneously and work with minimal supervision
- Familiarity with medical insurance, ASO/Commercial, Medicare, and coordination of benefits enrollment processes
- Familiarity with Tapestry’s automatic filing order table
- Exceptional attention to detail, organization, multitasking, planning, documentation, analytical, and problem-solving abilities
- Proficiency with Microsoft Office Professional Suite, including Outlook, Word, Excel, and Access, Internet Explorer, and EPIC
- Ability to sit for extended periods
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