- Purpose: Assist client with Billing and Enrollment issues for their Medicare program.
- Position Definition: Work through adverse scenarios impacting a member’s enrollment status in their Medicare policy.
- Apply premiums paid by members on their Medicare policy.
- Position Characteristics: Compile records, and evaluate personal and financial data. Keep records of assigned cases and prepare reports.
- Essential Duties and Responsibilities (include but are not limited to): Processes daily enrollee invoices and premium reconciliation for members · Reconciles un-allocated payments, monies, and premiums received from the individual subscriber or responsible party with the amount due for the healthcare program the member is enrolled in.
- Resolves invoice discrepancies prior to monthly report run.
- Performs month-end invoicing and accuracy audits. Resolve eligibility issues affecting premium billing. Generates reports and billing data using the premium billing module to be sent to print and fulfillment vendor.
- Reconciles eligibility data to ensure that the member data loaded in system matches the file (exception report).
- Works PCP exception report – assigns member to PCP.
- Works pharmacy exception report – validates eligibility updating system and website.
- Works vision exception report – validates eligibility and updates system.
- Works ID card exception report – validates member demographic information updating system accordingly and regenerates ID card as needed.
- Complete member moves – reassigning member from one PCP to another.
- Works monthly eligibility reconciliation (audit file/baseline vs. system) – updates eligibility data in system accordingly.
- Confirms monthly reporting. Validates eligibility by updating system accordingly using premium file details.
Knowledge, Skills and Abilities: Any combination of education, experience, and training that would likely provide the required knowledge and abilities in qualifying.
· EDUCATION/PREVIOUS EXPERIENCE
· General computer knowledge and typing skills, include 10 key by touch
· High School or equivalent
· 6 months to 1 year in similar role
· WORKING CONDITIONS
· Fast-paced production environment
· Must be able to sit and work extended periods of time
· Repetitive motion of hands, arms, and visual functions working on a computer
· Mandatory overtime as needed
· Able to work in team environment and able to adapt to changes quickly and efficiently.