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

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); 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; Researching and correcting errors, discrepancies, and rejected transactions; Monthly review and preparation of the CMS Enrollment Data Validation file and submissions; 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; 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, demonstrating 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

Nice to have

Associates Degree or higher