Enrollment Analyst – ACA Enrollment
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Job Description
Enrollment Analyst processing ACA Marketplace transactions, eligibility, reconciliations, and member records for WVU Medicine’s Peak Health plan. Supporting CMS compliance, Open Enrollment, UAT, training, and process improvement.
Responsibilities:
- Review, execute, and oversee processing of member enrollment application information for Peak Health’s Plan Suite
- Manage weekly enrollment files and daily ACA/Marketplace enrollment transactions
- Reconcile membership, coverage, Marketplace, issuer, and CMS records
- Maintain member enrollment records, including APTC and CSR information
- Process new enrollments, maintenance transactions, cancellations, terminations, reinstatements, plan changes, SEP requests, SNP applications, and 834 transaction files
- Resolve enrollment discrepancies, transaction errors, rejects, exceptions, and eligibility issues
- Complete EDV monthly processes, REED submissions, LEP data files, MPWR files, and CMS reconciliation processes
- Monitor enrollment work queues and meet production, quality, CMS, and organizational timeliness standards
- Respond to member inquiries regarding enrollment procedures, benefits, and eligibility requirements
- Develop and deliver department training to 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, identify trends and discrepancies, and prepare management reports
- Ensure compliance with CMS Marketplace regulations, federal and state regulations, issuer guidelines, and internal policies
- Collaborate with underwriting, billing, customer service, Marketplace representatives, vendors, and other stakeholders
- Maintain enrollment databases and software and troubleshoot system-related issues
Requirements:
- High school Diploma or equivalent
- Three (3) years of experience working with medical or institutional data entry
- Three (3) years of customer service experience
- Two (2) years of Medicare eligibility and Medicare Enrollment processing experience
- Preferred: Three (3) 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, CMS tools/resources, MARx, EDVs, REED Submissions, COB payment orders, and Tapestry’s AFO table
- At least one (1) year of experience with system/user acceptance testing
- At least one (1) year of experience with developing and delivering trainings
- Previous experience in EMR systems
- Working knowledge of administrative and clerical procedures, word processing, and managing files and records
- Ability to navigate multiple systems simultaneously and work with minimal supervision
- Familiarity with medical insurance, ASO/Commercial, Medicare, and ACA/Marketplace enrollment processes
- Exceptional attention to detail, organization, multitasking, planning, documentation, analytical, and problem-solving abilities
- Proficiency with Microsoft Office Professional Suite, Internet Explorer, and EPIC
- Ability to sit for extended periods of time
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