Membership Billing & Enrollment Repersentative
7 days left
- Employment Status
- Full Time
Humera is seeking multiple Membership Billing & Enrollment Representatives for our client in Minneapolis, MN. Our client is an independent, nonprofit health plan that provides health coverage and services. This is a long term contract position! Duties
- 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 departments.
- Other projects and duties as assigned.
- Two year degree or certificate in Business preferred
- demonstrated experience may be considered in lieu of degree.
- Three years' experience in a health insurance plan.
- Experience Excel spreadsheets and mail merge.
- Experience in researching and resolving complex issues.
- Phone experience.
- Proficient computer skills
- Knowledge of Microsoft office
- MACESS type software packages