Senior Membership Enrollment & Billing Rep
Posting ID: JP-001974829
Position Description This position is responsible for billing and enrollment processes. The goal is to be able to meet the needs of the department through flexibility in the distribution of work load and a focus on timely, accurate deliverables. Senior staff will be assigned to a product team as their primary focus, their work will not be restricted to one product depending on the department needs. This position consists of some data entry with an intermediate level of research and data compares. These duties include both billing and enrollment processes, such as: managing feeds, research and generation of attestations and letters, tracking responses, member outreach, making determinations, and the submission of data while ensuring compliance with regulatory and contractual requirements. Serving as a department resource and liaison to provide accurate timely responses and resolution to inquiries and complaints from members, authorized parties, and internal departments is an important function of this role. Assistance with department processing will be required as the department needs to meet deadlines and targets. ·Maintain knowledge of billing and enrollment requirements (all federal, state and contractual), processes and systems and ensure requirements and timelines are followed. ·Load and process applications and enrollment reports and files including; Verify data and ensure timely submission of membership information, ensure queues are empty at end of day and 21 day process is worked daily, reconcile payments addressing issues as identified and provide eligibility updates for Pharmacy. ·Support the Late Enrollment Penalty (LEP) and Out of Area (OOA) processes including; Research issues, create letters, making determinations, data submission, monitoring the process, participating in Quality Assurance reviews and providing monthly status reports to the manager, respond to telephonic inquiries and written requests from the CMS reconsideration vendor regarding a beneficiary request for appeal of LEP. Review LEP and OOA guidance, update letters or forms through the material review process to ensure continued compliance, track status and approval and member outreach when needed. ·Support billing and invoicing processes; including, validate the cash posting balances with the daily bank deposit log. Ensure member payments received have been properly applied to members invoice and that payments balance with the bank deposit, complete the error reports pertaining to EFT account information, ensure that the data received is accurate and active, validate the cash posting balances with the daily bank deposit log, when responses are received from the vendor, submit the appropriate change to CMS, track for return on TRR and send appropriate correspondence to member, analyze the monthly aging reports to identify members that have delinquent premium. Create and mail required member correspondence. Validate correct proposed termination notice is mailed to the correct members as well as termination submitted to CMS at the proper time each month and support cash application clean up across all lines of business. ·Manage Service Forms and member correspondence. Report trends/issues and assist in developing solutions. ·Research system issues, working to address discrepancies as identified and manage standard reports. ·Participate in process and quality improvement, department initiatives/plan and employee engagement. Provide input into department policies and procedures, including creating and maintaining Step by Steps work instructions. ·Ensure department meets expectations by participating in Quality Assurance reviews. ·Assist in departmental reporting and communication to other UCare departments. ·Other projects and duties as assigned.
Medical insurance, healthcare insurance, enrollment, provider enrollment, data entry, billing, research, process applications
Top Skills Details:
Customer service Billing Insurance
Additional Skills & Qualifications:
Education Two year degree or certificate in Business preferred; demonstrated experience may be considered in lieu of degree. Required Experience Three years’ experience in a health insurance plan. Experience Excel spreadsheets and mail merge. Experience in researching and resolving complex issues. Phone experience. Preferred Experience Proficient computer skills; knowledge of Microsoft office; and MACESS type software packages.
We know that a company's success starts with its employees. We also know that an individual's success starts with the right career opportunity. As a Best of Staffing® Client and Talent leader, Aerotek's people-focused approach yields competitive advantage for our clients and rewarding careers for our contract employees. Since 1983, Aerotek has grown to become a leader in recruiting and staffing services. With more than 250 non-franchised offices, Aerotek's 8,000 internal employees serve more than 300,000 contract employees and 18,000 clients every year. Aerotek is an Allegis Group company, the global leader in talent solutions. Learn more at Aerotek.com.
The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
Recruiter: Duckett, Alissa