Enrollment and Eligibility Coordinator

The Enrollment and Eligibility Coordinator tracks and maintains member enrollment, eligibility and program rosters.

Department: Health Services

Reports to: Dir, Field Care Management

Location: Waters Ave, Tampa, FL

Essential Functions:
  • Conducts telephone screening of applicants to determine eligibility and provide high level information regarding program
  • Works with Enrollment Nurses to schedule in-home assessment visits; reviews and tracks enrollment applications sent to LDSS
  • Conducts mail and telephonic outreach to assist members/family with processing Medicaid recertifications to ensure continuous eligibility in the program; forwards non-compliant response to SW team for follow-up
  • Coordinates enrollment/disenrollment/eligibility activities with CMS/LDSS and processes on Peradigm
  • Reviews and analyzes all required CMS/LDSS reports/rosters/premium files and compares to eligibility file
  • Proactively troubleshoots and takes initiative with CMS/LDSS to assure accuracy of outgoing/incoming eligibility information and provides solutions to issues with the data; determines extent and reason for discrepancies
  • Understands CMS and State Technology Systems in order to verify enrollment and eligibility, download and track files
  • Adheres to all HIPPA standards and confidentiality requirements
  • Associate’s Degree, preferred
  • Experience in a health related field, preferred or commensurate experience in Managed Care or other publicly funded insurance program
  • Experience in customer service, enrollment or operations in human services or a health care setting
  • Familiarity with Medicaid/Medicare concepts, practices, procedures and technology
  • Experience with Medicaid/Medicare enrollment practices, preferred
  • Bi-lingual skills, preferred
Computer Skills:
  • Intermediate knowledge of Microsoft Office including Outlook, Word and Excel

About us
Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses exclusively on providing government-sponsored managed care services through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans to families, children, seniors and individuals with complex medical needs. WellCare is a Fortune 500 company, and in 2018, was recognized as a Fortune "World's Most Admired Company", ranking in the top five among the health insurance and managed care industry-a testament to the hard work and dedication of the company's nearly 9,000 associates who each day live WellCare's values and deliver on its mission to help its members live better, healthier lives. The company serves approximately 4.4 million members nationwide as of Dec. 31, 2017. For more information about WellCare, please visit the company's website at www.wellcare.com. EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, creed, age, sex, pregnancy, veteran status, marital status, sexual orientation, gender identity or expression, national origin, ancestry, disability, genetic information, childbirth or related medical condition or other legally protected basis protected by applicable federal or state law except where a bona fide occupational qualification applies. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.