Jenny Cun

Develop and execute strategies to optimize the enrollment process. Ensure strict adherence to all Medicare enrollment regulations, guidelines, and policies. Responsible for preparation, processing, and maintenance of new members, re-enrollment, and disenrollments. Oversaw membership cards and member materials. Verify enrollment status, make changes to records, research and resolve enrollment system rejections. Work with other departments to resolve escalated CTM and address a variety of enrollment questions or concerns.

Knowledge/Skills/Abilities:

Oversight of enrollment, premium billing and reconciliation processes and all related staff

Monitored and enforced compliance with enterprise-wide processes and develops workflows for all staff to follow

Provides monthly reporting to management in support of functional processes

Complete analysis of data to ensure accuracy and oversight of data entered through both automated process and manual input

Lead and participated in state, federal, and internal audits

Strong knowledge to Medicare Manual Chapter 2 and PCUG

Strong relationship with health plan departments to facilitate working relationships. Such as Member Service, Broker Relations, Compliance, and Claims

Worked as SME for enrollment during SOX audit

Participated in meetings/calls with the CMS RO and Compliance as enrollment representative for Plan

Screened and recruited staff, ensuring candidates were a fit for team in terms of business need and company objectives

Ensures staff is compliant with regulatory and company guidelines, including HIPAA compliance

Identified potential risks, provides input on possible mitigation steps and implemented changes

Lead electronic enrollment website project with IT Analyst

Strong knowledge of MARX systems and Medi-cal state eligibility query

Responsible for ensuring timely reconciliation of eligibility files that meet regulatory and health plan requirements

Documented and maintained department workflows, job descriptions and policies as required to provide training and appropriate workflows