Membership Billing & Enrollment (MBE) Specialist

7 days left

Minneapolis, Minnesota
Apr 23, 2021
May 16, 2021
Employment Status
Full Time
Health Care that Starts with You!

Join a truly mission-driven organization! Independent, nonprofit UCare is recognized as one of the Minnesota's leading health plans. We provide more than 225,000 members across Minnesota and western Wisconsin with the health coverage plans and services they need to maintain and improve their health. The innovative coverage we create makes a difference for Medicare-eligible individuals, individuals and families enrolled in Minnesota Health Care Programs, such as MinnesotaCare and Medical Assistance, and disabled adults with special health care needs.

UCare is growing in size, membership, products, geographic coverage, and employees. We're an organization that's going places. Be part of a team that cares about you, be part of UCare.


Enter a highly collaborative environment where people are truly engaged, and feedback is valued. You'll enjoy a competitive salary and benefits, as well as a host of other perks, including a nationally recognized wellness program, and a bright, open, award-winning office space in Northeast Minneapolis just minutes from major freeways and retail centers.

At UCare, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.



ABOUT UCARE UCare offers Medicare, Medicaid, Individual and Family health plans - powered by the hardest working people in the industry. Our people powered teams de-complicate, advocate and always go the extra mile to help our members. We serve with integrity, compassion and commitment to do right by members, providers and government partners. Above all, we come to work excited to provide members a path for the best health of their lives.

WORKING AT UCARE Working at UCare is more than a career; it's a mission. A mission that defines us as professionals, unites us as an organization and shapes how we interact with our members and each other. Employees join UCare and stay because of the opportunity to have a purpose-driven job.

Our strong culture has established UCare as a Star Tribune Top 150 Workplace for 11 consecutive years since the awards program began. It's a culture that embraces innovative ideas, strategic partnerships, and exemplary customer and provider experiences. Working at UCare is being a part of a people powered team dedicated to making a real difference in the lives of our members and communities.


Position Description This position includes responsibilities for both billing and enrollment processes. The goal is to be able to meet the needs of the department through flexibility in the distribution of work load and a focus on timely, accurate deliverables. The specific tasks are generally assigned by the accountable team Supervisor or Manager. Although the Specialist will be assigned to a product team as their primary focus, their work will not be restricted to one product depending on the department needs. This position consists primarily of research, some data entry and performing complex compares. These duties include support of both billing and enrollment processes, through performing the more complex processing, file creation, data compares, Quality Assurance reviews, reconciliations, research, report submission and making determinations. It also involves working directly with members to resolve issues and responding to internal and external inquiries. It is essential that this position maintains a working knowledge of UCare products and ensures that all internal systems, vendors, State and CMS are in sync. This position is the primary day to day contact with the State and MNsure regarding Exchange issues.

• Demonstrate and maintain working knowledge of our products, our core operating systems and the detailed procedures to process enrollment and billing, ensuring regulatory and contractual obligations are met and internal policies and procedures are followed

• Assist with development, implementation, and managing the processes for identifying and tracking Medicare beneficiaries to ensure compliance with CMS regulations. Assist with maintaining the process for tracking all TRR codes and following CMS guidance

• Maintain and complete letters daily and with-in CMS TAT's for all all products. Complete the error reports received via MAT and reconcile dental and LIS's updates. Ensure that the data received is accurate and active

• Perform all reconciliations of SNP-MSHO and SNBC CMS Enrollment/Disenrollment's with CMS and DHS. Includes creating documentation to be submitted to the CMS Regional Office/Reed and Associates, matching of expected Enrollments and Disernollments based on UCare's core operating system data, DHS and CMS

• Verify and work daily enrollment reports from the vendor systems and monthly state membership files

• Load enrollment membership files for products, investigate and resolve errors to ensure members are accurately enrolled and billed. Ensure accurate and timely submission of membership information. Ensure queues are empty at the end of each day and 21 day process is worked daily

• Reconcile enrollment files and member specific information specific to APTC, CSR, broker, plan selection, number of members on plan and expected premium. Complete two-way compares to ensure data integrity and resolve and report issues to appropriate parties. Work with regulators, Sales and/or Billing to resolve discrepancies

• Reconcile daily enrollment reports/files to ensure that enrollment data has been processed and loaded - identify discrepancies and work across the team to resolve. Research members on Mnsurehold and Member on Review (MOR) to ensure accuracy and resolving discrepancies. Create suppress files as needed to maintain eligibility. Complete outreach calls as needed

• Research and support member services, CAG, Sales and Billing in resolving and responding to complex reconciliation issues and dual eligible issues. Research and verify member eligibility

• Maintain understanding of the Enrollment and Billing subsystems as it relates to the Billing and Enrollment procedures

• Respond to Service Form inquiries and written requests from members including from the CMS reconsideration vendor regarding a beneficiary request for appeal of LEP.

• When responses are received from the vendor, submit the appropriate change to CMS, track for return on TRR and send appropriate correspondence to member.

• Review and reconcile all ESI pre-edit reports for the TRR's and the ESI elig file. Maintain ESI eligibility updates for pharmacy across all lines of business

• Download MSHO and SNBC TRR's daily from Gentran and download them into MRRS Enrollment. Review CMS guidance on TRR processing. When updates are received make appropriate changes to our process

• 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 the department meets expectations by participating in Quality Assurance reviews.

• Assist in departmental reporting and communication to other UCare departments.

• Other projects and duties as assigned.

Four year degree in business or related field; demonstrated experience may be considered in lieu of degree.

Required Experience
Three years experience in a health insurance plan. Experience in

Excel spreadsheets and mail merge. Experience in researching and resolving complex issues. Phone experience.

Preferred Experience
Proficient computer skills; knowledge of Microsoft office; and knowledge of Medicare Exchange and Medicaid experience.

The UCare difference is our people power - employees actively working on the behalf of our members to get them access to the health care they need. We value and respect each individual's ideas and contributions, and provide the freedom to grow both personally and professionally. We are centrally located, and offer onsite education, equipment and wellness resources, and a myriad of volunteer activities. If you're looking for an inclusive environment that celebrates your people power, helps you build on your strengths and gives you the opportunity to truly make a difference, we invite you to apply.

As an Equal Opportunity/Affirmative Action Employer, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.

JOB POST DATE: 04/22/2021

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