Data Entry - Medical Billing and Enrollment Specialist


Colorado Springs, CO

Posted on Oct. 13, 2016

Provide information about insurance affordability programs and coverage options.
Educate consumers about insurance including deductibles, co-insurance, and premiums.

* 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.
* Collaborates with enrollment team to resolve eligibility issues affecting premium billing.
* Generates reports and billing data using the premium billing module to be sent to print and fulfillment vendor.
* 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.


* High School Diploma or G.E.D.
* 2 plus 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

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