Senior Enrollment Representative

Ampcus Inc. is a certified global provider of a broad range of Technology and Business consulting services. We are in search of a highly motivated candidate to join our talented Team.

Job Title: Senior Enrollment Representative

Location(s): Los Angeles, CA
(Remote)


Job Summary
We are seeking an experienced Sr. Enrollment Representative to support Medicare enrollment operations in a remote environment. The ideal candidate will have hands-on experience with 834 EDI transactions, State (CA Client) and CMS enrollment files, and a strong understanding of Medicare enrollment, reconciliation, and benefits coordination. Experience in Managed Care, Medicare, and Medicaid enrollment, along with business analysis and process improvement, is highly preferred.

Key Responsibilities

• Process and manage Medicare enrollment, disenrollment, and reconciliation activities.
• Work with 834 EDI transactions and State (CA Client) and CMS enrollment files.
• Support all aspects of Enrollment Operations, including Medicare membership enrollment and benefits coordination.
• Investigate and resolve enrollment discrepancies to ensure data accuracy and regulatory compliance.
• Perform reconciliation of enrollment records and identify data inconsistencies.
• Analyze enrollment processes and recommend process improvements.
• Ensure compliance with CMS and Medicare enrollment regulations and guidelines.
• Utilize Microsoft Office applications and data visualization tools for reporting and analysis.
• Prioritize multiple assignments while meeting changing deadlines.
• Collaborate with cross-functional teams to support enrollment operations.

Required Qualifications

• High School Diploma or equivalent.
• 3-5 years of experience in a Medicare Health Plan or Managed Care environment with a focus on:
  • Medicare Enrollment
  • Disenrollment
  • Reconciliation
• Experience working with 834 EDI transactions.
• Experience with State (CA Client) and CMS enrollment files.
• Strong knowledge of Medicare and CMS enrollment and billing regulatory requirements.
• Working knowledge of Microsoft Office Suite (Excel, Word, and PowerPoint).
• Experience using data visualization tools.
• Strong understanding of healthcare models and Managed Care/MSO operations.
• Excellent analytical, critical thinking, and problem-solving skills.
• Ability to manage multiple priorities in a fast-paced environment.
• Reliable attendance and adherence to established scheduling standards.

Preferred Qualifications

• Managed Care experience.
• Medicare and Medicaid enrollment experience.
• Business analysis and process improvement experience.
• Experience supporting benefits coordination operations.

Required Skills

• Medicare Enrollment
• Enrollment Reconciliation
• Disenrollment
• 834 EDI
• CMS Regulations
• State (CA Client) Files
• Microsoft Excel
• Data Analysis
• Managed Care
• Critical Thinking
• Process Improvement
• Benefits Coordination
• Healthcare Operations

Ampcus is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veterans or individuals with disabilities.