Posted on Sep. 22, 2016
Assist client with Billing and Enrollment issues for the client's Marketplace program. Including processing and data entry.
* Work through adverse scenarios impacting a member's enrollment status in their Marketplace policy.
* Apply premiums paid by members on their Marketplace policy.
* 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): DUTIES AND RESPONSIBILITIES:
* Processes daily enrollee invoices and premium reconciliation for members
* Reconciles unallocated 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 fulfillmentvendor.
* 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.
Any combination of experience and training that would likely provide the required knowledge and abilities in qualifying.
QUALIFICATION, SKILLS, EXPERIENCE:
* High School Diploma or G.E.D.
* 1+ years experience in insurance health plans helpful
* Basic computer skills, including MS Word, Excel, Outlook
* Excellent communication (verbal and written) and customer service skills
* Detail-oriented; ability to organize and multi-task
* Ability to make decisions based on eligibility program design as appropriate
* Basic office equipment experience such as: computer, printer, copier, telephone/fax
* Education: High School Diploma or equivalent.
* Work Experience: Customer Service experience preferred.
* Cognitive Skills include language, basic math skills, reasoning ability and verbal communication skills
* Computer Skills: Basic computer knowledge and excel experience required
Environmental Conditions Generally works in office environment.
Essential functions may require maintaining physical condition necessary for standing, walking, sitting, use hands to finger, handle, or feel; reach with hands and arms; and talk or hear. Specific vision abilities required by this job include close vision and ability to adjust focus.
* Sitting for long periods
* Repetitive hand/finger motion (using keyboard)
* Stressful Situations with time constraints