ForgeApplyTry it free

ForgeApply · Job listing

Enrollment Validation Specialist - Denver Health Medical Plan (Weekly On Site Requirement)

Denver Health

Administrative Offices - 601 Broadway, Denver, US$67k – $101khybrid

See all 305 open roles at Denver Health →

Tailor your resume for this Denver Health job in about a minute.

ForgeApply tailors your resume and cover letter to this exact posting, then hands you a ready-to-submit application for Denver Health's site. Free trial, no card required.

Tailor my resume for this jobView original posting →

About this role

We are recruiting for a mission-driven Enrollment Validation Specialist - Denver Health Medical Plan (Weekly On Site Requirement) to join our team! We're with you for life’s journey. At Denver Health, purpose isn’t just something we believe in—it’s something we live every day, for life’s journey.

Our Values Respect | Belonging | Accountability | Transparency

Department Managed Care Administration

* Must Live in Colorado * This is a hybrid role located in Denver, Colorado with a requirement of being in the office 2 days per week.

Job Summary

Under minimal supervision, contributes to the daily operations and analysis of enrollment related activities for all lines of business for the Denver Health Medical Plan. Compiles and analyzes reports for fallout and coordination of benefits, MedImpact, 834s. Reconciles complex sets of data received in order to validate reporting. Works and collaborates directly with the manager, and other partners such as all levels of management and employees, plan members, external consultants, DHAA, State and Federal entities and other community organizations to improve enrollment process and optimization of systems.

Essential Functions : • Collaborates with strategic initiatives and operations for the Health Plan Enrollment team. (10%) • Works independently and with other Managed Care Departments to compile reports, attestations, and other submissions to submit to the State and CMS/HPMS (10%) • Collaborates with other departments to compile, analyze and ensure the accuracy of data and documentation for internal and external compliance audits (10%) • Development and adherence to enrollment processes, policies and procedures. (10%) • Resolve claim concerns or member access issues related to enrollment and coordination of benefits. (5%) • Reconciles complex sets of data received from CMS or the State in order to validate reporting, financial reconciliation, and encounter submissions to align with established goals and metrics (5%) • Actively identifies problems and opportunities for improvement; identifies appropriate solutions and involves other in the implementation process (5%) • Validate member enrollment and disenrollment. (5%) • Partner with other departments to include Claims, Pharmacy, and IS in developing solutions as issues arise. (5%) • Ensure compliance with all applicable Federal and State rules and regulations, validating contractual enrollment requirements are reflected in plan enrollment system. (5%) • Analyze and reconcile data including claims, 834, and 820 files for trends and discrepancies, reporting any operational deficiencies to the Manager. (5%) • Load electronic eligibility files and capitation files in 834 and 820 format. (5%) • Monitor and assess electronic file uploads to ensure data quality. (5%) • Analyze Special Enrollment documentation provided from members to determine Commercial coverage eligibility. (5%) • Identify issues with enrollment, trend and perform root cause analysis for all lines of business. (5%) • Utilize various data analysis tools such as Tableau, Excel and SQL to create reports for department and organizational use. (5%)

Education : • Bachelor's degree required

- OR - • 4 additiona l relevant years of experience in lieu of a degree required

Work Experience : • Four years of direct health care experience with a specific emphasis on Government Health Program operations, regulatory issues, policy development, or compliance required

Licenses : Knowledge, Skills and Abilities : • Extensive knowledge of managed care, Medicare, Medicaid and CHP+ eligibility and enrollment requirements, rules, and processes desired. • Knowledge of Federal and Colorado State statutes, legislative initiatives and regulations, as well as Federal, State and local policies. • Ability to develop data requirements and work with operations teams and groups to extract, organize and analyze data and trends. • Ability to define problems: collect data, establish facts and draw valid conclusions to implement solutions. • Skilled in analytical thinking, problem solving, and process improvement. • Critical thinking, strong written and verbal communication skills, and the ability to effectively interact within a team. • Microsoft Office Suite • Tableau • Proficiency in Health Plan Management Software involving Claims, Enrollment systems, and Government Data Portals. Knowledge of PC applications, specifically Microsoft Office products, and the ability to learn to computer applications.

* Must Live in Colorado * This is a hybrid role located in Denver, Colorado with a requirement of being in the office 2 days per week.

Shift Days (United States of America) Work Type Regular Salary $67,300.00 - $101,000.00 / yr

Benefits

At Denver Health, we take care of the people who take care of our community. Our benefits are built to support your life, your family, and your future — with generous paid time off, fully paid parental leave, exceptional retirement contributions, comprehensive health coverage, and nationally recognized well-being programs. We invest in your growth through tuition assistance, career advancement pathways, and professional development — while also offering meaningful financial advantages through loan forgiveness eligibility and employer contributions. When you join Denver Health, you’re joining a mission-driven organization that invests in you.

Here is a small list of our benefit programs: • Paid time off starting at 28 days per year, inclusive of vacation, personal/sick, and 7 Holidays • 100% paid parental leave up to 6 weeks • Immediate eligibility for retirement plans with employer contribution up to 9.5% • Generous medical, dental, vision plans in addition to employer paid disability and life insurance. • Comprehensive well-being programs including on-site employee fitness center located on Denver Health main campus and nationally recognized RESTORE Center • Free RTD EcoPass (public transportation) • Childcare discount programs

Salary insight

The midpoint of this range ($84k) is about 32% below the median disclosed salary for Denver roles listed on ForgeApply ($123k across 1,209 jobs).

Based on live postings with disclosed pay on ForgeApply; refreshed daily. Not an estimate of this employer's offer.

Tailor your resume for this Denver Health role before you apply.

Tailor my resume for this job

Similar jobs

Free ATS checker · How to Tailor Your Resume to a Job Description (Step by Step)