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Enrollment Specialist 


Peak TPA is a third party administrator (TPA) that provides back-office functions for capitated health plans. Back-office functions include but are not limited to claims adjudication, member enrollment and reporting, and financial reporting. Peak TPA's partner company, Mediture/Cognify, has a long history in providing software solutions for managing care coordination for capitated health plans. Both companies (subsidiaries of Tabula Rasa Healthcare Company) work closely together to provide integrated and intuitive products to our health plans.

Peak TPA's goal is to seamlessly handle our client's back-office functions to allow the plan to financially thrive and grow so they can focus on member care coordination.

Summary: Under the supervision of the Enrollment Supervisor, the Enrollment Specialist is responsible for coordinating the enrollment process for all clients.

Essential Functions:

  • Enter enrollees into system monthly
  • Submit Enrollment Files to CMS monthly
  • Place enrollment file on FTP site monthly
  • Check DTRR reports daily
  • Follow-up on any issues appearing on the DTRR
  • Place MMR in Excel on FTP site
  • Submit MMRs, HCC MORs & Rx HCC MORs to PDAC monthly
  • Submit retroactive adjustments to Reed & Associates or CMS regional office as needed
  • Submit attestation information to clients monthly
  • Completes Enrollment Data Validation (EDV) Audits
  • Follow up on enrollment issues
  • Communicate any outstanding enrollment issues to clients
  • Create and distribute to clients the participant insurance cards and badges
  • Review the A/R aging each week
  • Coordinate follow-up with the Accounting department for any A/R balances
  • Participate in special projects as requested
  • Other duties as assigned

Additional Functions:

  • Communicates clearly and concisely, with sensitivity to the needs of others
  • Maintains courteous, helpful and professional behavior on the job; displays a willingness and ability to be responsive in a warm and caring manner to all customer groups; consistently cooperates and supports organization in problem solving issues; ensures customer satisfaction by understanding and applying the Customer Service Policy, Procedure and Standards; will support the success of the entire team; establishes and maintains effective working relationships with co-workers
  • Follows all Policies and Procedures and HIPAA regulations
  • Maintains a safe working environment
  • Maintains the confidentiality of all company procedures, results, and information about participants, clients, providers and employees
  • Establishes and maintains effective working relationships with co-workers

Supervisory Responsibility: None

Travel: Minimal travel, less than 10% is expected for this position.

Position Requirements

Knowledge, Skills and Abilities:

  • Educational requirements include a high school diploma or equivalent. Three years of experience in a healthcare environment, and a working knowledge of Medicare preferred
  • Current knowledge and understanding of Medicare regulations related to PACE health plan management; two years enrollment experience in PACE strongly preferred
  • Knowledge and experience using computerized accounting systems, Excel, Microsoft Word and ten-key efficiency
  • Strong knowledge of current computer technology, including the use of computers, printers, computerized file structures and associated software
  • Skilled in establishing and maintaining effective working relationships with co-workers and clients
  • Skilled in problem resolution; recommends suggestions to increase accuracy and/or efficiency
  • Detail-oriented with ability to focus on projects for extended periods
  • Ability to work independently, seeking supervision as needed
  • Ability to communicate professionally, clearly and effectively, verbally and in writing
  • Ability to have superior attendance to effectively fulfill all functions of the position
  • Ability to independently follow through on assigned tasks, without prompting
  • Ability to prioritize effectively
  • Ability to consistently multitask

Physical Demands & Requirements:

  • Communicate by way of the telephone with participants, customers, vendors and staff
  • Operate a computer and other office productivity machinery, such as a calculator, copy machine, fax machine and office printer
  • Remain stationary for extended periods of time
  • Occasionally exert up to 20 pounds of force to lift, carry, push, pull or move objects
  • Visual acuity to perform activities such as identifying, inputting and analyzing data on a computer terminal and/or in hard copy
  • Occasional reaching to retrieve shelved items
  • Occasional bending/stooping

Work Environment:

  • This job operates in a professional office environment with a conversational noise level.
  • No substantial exposure to adverse environmental conditions is expected
  • Moderate pressure to meet scheduled appointments and deadlines
  • Potential for occasional verbal aggression by clients and vendors
Full-Time/Part-Time Full-Time  
Shift Days  
Position Enrollment Specialist  
Post Internal Days 0  
Number of Openings 1  
Location Peak Health Plan Management- St Louis, MO  
About the Organization  
EOE Statement We are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status or any other characteristic protected by law.  
Cell None Specified 

HoursPerWk None Specified 

supervisorUID None Specified 

This position is currently not accepting applications.

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