Humera has a position available for a Reconciliation Representative with our client in Minneapolis, MN. The candidate in this position will be responsible for the accurate and timely processing of the Billing department functions - Medicare Risk product, Senior Select and other Exchange products, which includes but is not limited to member premium payment application, member refunds and member premium returns across all products. Review and entry of all EFT forms, changes and terminations and analyzing the EFT and termed aging.
- Maintain a production and quality level of 99% or better in performing Billing cash functions and a quality level of 95% or better in performing all other Billing functions
- Process member premium payments in the core operating system and post to members account in an accurate and timely manner, within 72 hours of the bank processing the payment
- Perform a daily reconciliation of the premium payments that were posted to members? accounts
- Process all member refunds in the core operating system
- Reconcile all returned items that are received from the bank; making all necessary changes to the members account in the core operating system
- Process member EFT (Electronic Funds Transfer) request, including mailing of EFT application, mailing of member EFT start-up letters, entry of application into the core operating system, entry of changes to account information, termination of EFT
- Post EFT payments in the core operating system to members account in an accurate and timely manner
- Research and process the EFT members aging and terminated member aging
- Includes verification of outstanding balance, adjusting EFT pull (credit), creating outstanding EFT balance (debit) letters, requesting member refunds as needed and writing off bad debt balances as identified for terminated members each month
- Validate the monthly EFT file before submission to the financial institution
- validate members monthly premium, validate members premium balance and validate member is active
- Create and mail retro LICS co-pay letters to our members
- Ensure any payments recouped are not applied to the members premium payments
- Create and mail/email our Group Billed Group invoices as required based on our group contract
- Monitor and track newborns enrolled in the core operating system. Includes verification of payment from DHS, communication with counties and/or DHS validating information received, working with Enrollment to ensure the core operating system divisions are changed once payment is received, verification that newborn is terminated if payments not received.
- Create and maintain clear step by step processes for each function
- Support the reconciliation of all CMS payments. Assisting with the reconciliation process as needed
- Support cash application clean up across all lines of business
- Maintain an understanding of the core operating computer system and a comprehensive knowledge of the Enrollment Subsystem and the Billing Subsystem as it relates to the Billing and Reconciliation Procedures
- Maintain an understanding and apply the requirements in CMS/DHS regulations and the model CMS audit guide as it relates to the components of payments received from CMS for MSHO product.
- Assist in the departmental reporting functions from Membership Billing and Enrollment to other departments, as needed
- Other projects and duties as assigned
- Two year degree or certificate in Business or Accounting preferred; equivalent experience will be considered in lieu of degree.
- Two years of experience with accounts receivable processing, accounting journal entries and reconciliation.
- Experience with data entry and accounting/billing principles
- Two to four years related billing experience within a health care environment