Membership Accounting Analyst (Billing)

The Membership Accounting Analyst is responsible for the timely and accurate resolution of discrepancies identified in the Enrollment, Billing and/or Reconciliation processes. The analyst will review documentation, work items in queues and correct errors, identify trends and document resolutions.

Responsibilities

Enrollment Processing

• Process queue items, inter-departmental and customer requests timely and accurately.
• Review incomplete and pending enrollment applications and disenrollment forms for correction and submission to Centers for Medicare & Medicaid Services (CMS)
• Review and complete Late Enrollment Penalty (LEP) Attestations
• Review and complete Other Health Insurance (OHI) verification and error correction
• Review and create retro processing packets to be submitted to the CMS Retro Processing Contractor (RPC)

Billing Processing

• Identify and post customer payments not automatically applied by the appropriate system
• Respond to billing-related correspondence
• Review and investigate returned checks, rejected ACH and credit card transactions
• Process requests for automated premium payment via credit card or ACH withdrawal
• Review and approve/deny customer requests for premium refunds in accordance with established policies.
• Monthly State Pharmaceutical Assistance Programs reconciliation

Reconciliation Processing

• Researching and correcting errors, discrepancies, and rejected transactions.
• Monthly review and preparation of the CMS Enrollment Data Validation file and submissions.

All Functions

• Working understanding of Centers for Medicare & Medicaid Services (CMS) guidance
• Conform with and abide by all regulations, policies, work procedures and instructions
• Meet CMS guidelines and client Service Level Agreement (SLA) requirements through the proper handling of transactions
• Perform outbound calls to customers or other entities as permitted to complete processing of enrollment, disenrollment, billing and or reconciliation transactions
• Make appropriate system corrections and escalate transactions that are unable to be corrected
• Prepare reports as requested by management
• Perform other duties and responsibilities as required

Requirements

• High school diploma required; Associates Degree or higher preferred.
• Minimum 2 years Health Plan Operations experience including; Customer Service, Enrollment, and or Claims processing
• Excellent analytical, decision-making, problem-solving, team, and time management skills
• Excellent oral and written communication skills
• Display positive demeanor, technical accuracy, and conformity to company policies
• Ensure HIPAA regulations are maintained within the immediate environment
• Communicate with coworkers, management, staff, customers, and others in a courteous and professional manner
• Conform with and abide by all regulations, policies, work procedures and instructions
• Knowledge of customer service best practices and principles.
• Excellent data entry and typing skills.
• Superior listening, verbal, and written communication skills
• Ability to handle stressful situations appropriately, while demonstrating empathy.
• Resourceful, great at solving unstructured problems with little to no supervision in a fast-paced, high stakes environment.
• Team Player: Demonstrates a strong ability to contribute to the business along with business unit team members and managers; establish collaborative relationships with peers.
• Possess strong interpersonal skills and the ability to establish, develop, and maintain business relationships.
• Excellent written and verbal skills