Enrollment and Billing Representative II

2 weeks ago

Bend, United States PacificSource Full time
Looking for a way to make an impact and help people?

Join PacificSource and help our members access quality, affordable care

PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.

Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.

This position processes billing and enrollment updates for the Medicare and Medicaid line of business and maintains established procedures to process a multitude of transactions.

Essential Responsibilities:
  • Efficiently and accurately completes the Essential Responsibilities of the Enrollment & Billing Representative I position.
  • Process payment files and stage for the nightly batch; including but not limited to Lockbox.
  • Reconcile Medicare accounts balances and determine accuracy by utilizing Excel.
  • Review and analyze data for accuracy to provide billing to members. Input data on accounts receivable adjustments within strict billing timelines.
  • Work the financial queue reports; including but not limited to delinquency, balance after termination, SSA members with balances and negative billed members.
  • Draft and send delinquent letters to Medicare members.
  • Receive and process Good Cause Reinstatement requests.
  • Submit retroactive processing requests to the RPC and work with the CMS Regional Office as needed to review any enrollment discrepancies.
  • Work all aspects of the Late Enrollment Penalty including but not limited to, initial letters, rescinding LEP, work LEP TRC's, and respond to all Maximus requests and decisions.
  • Perform Upgrade Testing for the EAM and Facets systems utilized by the Enrollment and Billing department.
  • Run and work the daily DTRR's including annual LIS Rider letters.
  • Run and work daily MMS, XMS, EAM to Facets Validation and all aspects of the ID Card & Packet Timeliness Reports.
  • Request Information from the beneficiary when enrollment forms are incomplete and process denial of enrollment within CMS compliance guidelines.
  • Medicare enrollment commissions using the Onbase and Facets systems.
  • Process all voluntary and involuntary disenrollment's within CMS compliance guidelines.
  • Create and maintain Medicare and Medicaid department procedures.
  • Work the Medicare Dual report by contacting the state DHS workers to verify eligibility and confirm enrollments and disenrollment's in the CCOA/CCOB.
  • Work the Medicaid EMS Pended transaction fallout daily.
  • Respond to all emails in the Medicaid Inbox including communicating with the state to verify eligibility and updating Facets eligibility as necessary.
  • Process daily returned mail, making any related changes in EAM & Facets contacting the member if needed, and resending documents or processing as required by CMS.
Supporting Responsibilities:
  • Back up Enrollment & Billing Representative I, as needed.
  • Follow company and department policies.
  • Meet department and company performance and attendance expectations.
  • Provide backup support for other members of the enrollment team.
  • Support and participate in continuous improvement initiatives.
  • Maintain professional, service oriented relationships.
  • Ability to judge severity of problems and need to escalate to management as necessary.
  • Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
  • Perform other duties as assigned.
Work Experience: Minimum of 4 years of administrative experience with at least 1 year in health insurance billing experience required. Demonstrated ability to conduct detailed research, collect data and review system reports.

Education, Certificates, Licenses: High School diploma or equivalent required. Associate's Degree preferred.

Knowledge: Ability to understand and interpret Federal and Oregon State laws and contract provisions. Advanced proficiency in Microsoft Office Applications. Excel experience to include formulas, sorts, and filters. Requires the ability to articulate problem statements, collect data and establish facts. Demonstrated organizational and time management skills.

Competencies:

Building Customer Loyalty

Building Strategic Work Relationships

Contributing to Team Success

Planning and Organizing

Continuous Improvement

Adaptability

Building Trust

Work Standards

Environment: Work inside in a general office setting with ergonomically configured equipment.

Skills:
Accountability, Communication, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork

Our Values

We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:
  • We are committed to doing the right thing.
  • We are one team working toward a common goal.
  • We are each responsible for customer service.
  • We practice open communication at all levels of the company to foster individual, team and company growth.
  • We actively participate in efforts to improve our many communities-internally and externally.
  • We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
  • We encourage creativity, innovation, and the pursuit of excellence.


Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.

  • Enrollment and Billing Representative II

    3 weeks ago

    Bend, United States PacificSource Full time

    Looking for a way to make an impact and help people?Join PacificSource and help our members access quality, affordable care!PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status,...

  • Enrollment and Billing Specialist

    3 weeks ago

    Bend, Oregon, United States PacificSource Full time

    About PacificSourcePacificSource is an equal opportunity employer dedicated to making a positive impact in the lives of our members.Job SummaryWe are seeking a highly motivated and detail-oriented Enrollment and Billing Representative II to join our team. As a key member of our team, you will play a critical role in helping our members access quality,...

  • Enrollment and Billing Specialist

    5 days ago

    Bend, Oregon, United States PacificSource Full time

    Job Title: Enrollment and Billing Representative IIPacificSource is seeking a highly skilled Enrollment and Billing Representative II to join our team. As a key member of our enrollment team, you will be responsible for processing billing and enrollment updates for our Medicare and Medicaid line of business.Key Responsibilities:Efficiently and accurately...

  • Enrollment and Billing Representative I

    13 hours ago

    Bend, Oregon, United States PacificSource Full time

    Make a Difference in HealthcarePacificSource is seeking a skilled Enrollment and Billing Representative I to join our team. As a key member of our Government Line of Business team, you will be responsible for processing a multitude of transactions, including demographic updates, notification letters, enrollments, disenrollments, reinstatements, and plan...

  • Enrollment and Billing Specialist

    1 month ago

    Bend, Oregon, United States PacificSource Full time

    About the RolePacificSource is seeking a highly organized and detail-oriented Enrollment and Billing Representative to join our team. As a key member of our Government Line of Business team, you will be responsible for processing a multitude of transactions, including demographic updates, notification letters, enrollments, disenrollments, reinstatements, and...

  • Enrollment and Billing Specialist

    1 month ago

    Bend, Oregon, United States PacificSource Full time

    About the RolePacificSource is seeking a highly organized and detail-oriented Enrollment and Billing Representative to join our team. As a key member of our Government Line of Business team, you will be responsible for processing a multitude of transactions, including demographic updates, notification letters, enrollments, disenrollments, reinstatements, and...

  • Enrollment and Billing Specialist

    3 weeks ago

    South Bend, Indiana, United States PacificSource Full time

    Job SummaryPacificSource is seeking a highly organized and detail-oriented Enrollment and Billing Representative to join our team. As a key member of our enrollment team, you will be responsible for processing a multitude of transactions for Government line of business, including demographic updates, notification letters, enrollments, disenrollments,...

  • Enrollment and Billing Representative I

    3 weeks ago

    Bend, United States PacificSource Full time

    Looking for a way to make an impact and help people?Join PacificSource and help our members access quality, affordable care!PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status,...

  • Enrollment and Billing Representative I

    1 month ago

    North Bend, United States PacificSource Full time

    Looking for a way to make an impact and help people? Join PacificSource and help our members access quality, affordable care! PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status,...

  • Enrollment Specialist

    2 months ago

    Bend, United States Mosaik Medical Full time

    Mosaic Community Health prides itself on being an innovative health system that pioneers unique and creative ways to provide and improve patient access to health care. Since our founding in 2002 we have proudly served insured and uninsured patients regardless of age, ethnicity, or income. We focus on a holistic approach to patient care by incorporating...

  • Enrollment Specialist

    3 weeks ago

    Bend, Oregon, United States Mosaic Medical Full time

    About Mosaic Community HealthMosaic Community Health is a dynamic and innovative health system that prides itself on providing unique and creative ways to improve patient access to healthcare. With a strong commitment to serving insured and uninsured patients, regardless of age, ethnicity, or income, we strive to make a meaningful difference in the lives of...

  • Enrollment Coordinator

    1 month ago

    Bend, Oregon, United States Mosaic Medical Full time

    About the RoleMosaic Community Health is seeking a highly skilled Enrollment Specialist to join our team. As a key member of our staff, you will play a critical role in ensuring that our patients have access to the healthcare services they need.Key ResponsibilitiesAid and process state and/or federal applications for insurance coverage for patients and...

  • Billing Customer Service Representative

    4 weeks ago

    South Bend, Indiana, United States Medix Full time

    Job Summary:We are seeking a highly skilled Billing Customer Service Representative to join our team at Medix. As a key member of our customer service team, you will be responsible for providing exceptional service to our patients and pharmacy partners. Your primary focus will be on handling inbound calls, emails, and resolving billing-related issues. If you...

  • Billing Customer Service Representative

    4 weeks ago

    South Bend, Indiana, United States Medix Full time

    Job Summary:We are seeking a highly skilled Billing Customer Service Representative to join our team at Medix. As a key member of our customer service team, you will be responsible for providing exceptional service to our patients and pharmacy partners. Your primary focus will be on handling inbound calls, emails, and resolving billing-related issues. If you...

  • Phlebotomist II

    3 weeks ago

    Bend, United States InterSources Full time

    Job Description: The Patient Services Representative II (PSR II) represents the face of our company to patients who come in, both as part of their health routine or for insights into life-defining health decisions. The PSR II draws quality blood samples from patients and prepares those specimens for lab testing while following established practices and...

  • Medical Billing Specialist

    4 days ago

    South Bend, Indiana, United States US01 AllCare Plus Pharmacy, Inc. Full time

    Care Manager Job DescriptionWe are seeking a highly skilled Care Manager to join our team at US01 AllCare Plus Pharmacy, Inc. The ideal candidate will have a strong background in medical billing and insurance verification, with excellent communication and interpersonal skills.Key Responsibilities:Contact insurance companies to obtain correct eligibility...

  • Phlebotomy Specialist II

    11 hours ago

    Bend, Oregon, United States Bayone Full time

    Job Description:The Patient Services Representative II (PSR II) is the face of our company, representing Bayone to patients who visit our facilities. This role involves drawing quality blood samples from patients and preparing those specimens for lab testing while following established practices and procedures. The PSR II has direct contact with patients,...

  • Phlebotomy - Phlebotomist II

    2 weeks ago

    Bend, United States TalentBurst Full time

    Job Title: Phlebotomist IILocation: Bend OR Duration: 5+ Months extendable contractShift/Time Zone: Mon to Fri 8.30Am to 5PmJob Description: The Patient Services Representative II (PSR II) represents the face of our company to patients who come in, both as part of their health routine or for insights into life-defining health decisions. The PSR II draws...

  • Phlebotomy - Phlebotomist II

    3 weeks ago

    Bend, United States TalentBurst Full time

    Job Title: Phlebotomist IILocation: Bend OR Duration: 5+ Months extendable contractShift/Time Zone: Mon to Fri 8.30Am to 5PmJob Description: The Patient Services Representative II (PSR II) represents the face of our company to patients who come in, both as part of their health routine or for insights into life-defining health decisions. The PSR II draws...

  • Phlebotomy - Phlebotomist II

    3 weeks ago

    Bend, United States TalentBurst Full time

    Job Title: Phlebotomist II Location: Bend OR Duration: 5+ Months extendable contract Shift/Time Zone: Mon to Fri 8.30Am to 5PmJob Description: The Patient Services Representative II (PSR II) represents the face of our company to patients who come in, both as part of their health routine or for insights into life-defining health decisions. The PSR II draws...