Jobs in Rhode Island 2026 (Now Hiring) - Smart Auto Apply
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Enrollment Coordinator
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Enrollment Coordinator
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Job Description
- Submits, maintains, and monitors applications for Initial enrollment and Revalidation with Government Medicaid Payer and Commercial Payers for Clinics and Providers in order to ensure active participation.
- Provides assistance in developing and improving payer workflow while ensuring compliance with the company's regulatory, safety, quality, and confidentiality protocols and standards.
- Responsible for ensuring the timely and accurate submission of Group and Provider enrollment applications for Medicaid and Commercial programs, supporting compliance and operational efficiency across payer relations.
- Responsible for minimizing the deactivation of government program applications by adhering to established quality control procedures.
- Serves as a key point of contact for escalated claim issues received from internal departments, coordinating with payers to identify and implement solutions.
- Communicates resolutions and relevant updates to appropriate internal stakeholders to ensure alignment and continuity.
- The Coordinator III will work directly with other coordinators to ensure quality of work delivered, performance/productivity benchmarks are met, and all compliance related issues are properly addressed, trained and coached on a consistent basis.
- The Enrollment Coordinators play a critical role in working with our new member clients to determine eligibility and perform various enrollment activities.
- Enrollment Coordinators interface with both individual plan members and employer group and requires a strong focus around accurate and timely customer support to ensure client enrollment and retention.
- The Enrollment Coordinator III reports directly to the Enrollment Supervisor, also functioning as SME (Subject Matter Expert) in the functions, processes, and eligibility procedures as they relate to Medicare Part D enrollment and CMS (Center for Medicare/Medicaid Services) Standards.
- At least 1 year of overall related experience of Center for Medicare/Medicaid Services (CMS) guidelines for Medicare Part D enrollment processes or previous work experience in regulatory environment.
- Comfortable in both team player and team roles.
- Dependable/Responsible/Accountable Excellent spoken and written communication skills Capable of managing through transition, while fostering a positive team environment Confident in decision making ability within strict timelines Exceptional prioritization and organizational skills Acts with integrity and uses sound judgment in dealing with confidential information
- High school diploma or GED required, Bachelors Degree in Business Administration, Marketing, Finance or similar field preferred and have 2+ years of relevant work experience.
- Health Benefits
- Referral Program
- Excellent growth and advancement opportunities
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