Enrollment & Billing Specialist III

4 weeks ago

Baton Rouge, United States Blue Cross and Blue Shield of Louisiana Full time

We take great strides to ensure our employees have the resources to live well, be healthy, continue learning, develop skills, grow professionally and serve our local communities. We invite you to apply for a career with Blue Cross.

Residency in or relocation to Louisiana is preferred for all positions.

Grade 05

POSITION PURPOSE

The Enrollment and Billing Specialist III is able to perform the duties of both the E&B Specialist I and II. Research, resolve and respond to complex issues and concerns on behalf of both internal and external customers. Maintain accurate and up-to-date membership records to ensure correct premium billing and claim processing within contract limits. Calculate and process refunds in FACETS and coordinate with the Accounting Dept for disbursement. Research and respond to internal high-priority cases or urgent inquiries. Work cohesively in a team and shift work tasks and priorities as needed.

NATURE AND SCOPE

  • This role does not manage people
  • This role reports to this job: SUPERVISOR, ENROLLMENT & BILLING
  • Necessary Contacts: In order to effectively fulfill this position, the incumbent must be in contact with:

    Accounting, Actuarial, BET, Claims, Compliance, Customer Service, Finance, Legal, Sales and Marketing, Underwriting, IT, District Offices, Producers, Group Leaders, Brokers, 834 vendors and all levels of Enrollment and Billing personnel and other BCBSLA departments as needed.
QUALIFICATIONS

Education
  • High School Diploma or equivalent is required
  • Associate's is preferred

Work Experience
  • 4 years of clerical experience is required
  • 2 years of Enrollment and Billing experience across different E&B units is required
  • Required experience can run concurrently
  • Customer Service or Marketing experience is preferred
Skills and Abilities
  • Must have thoroughly understand insurance and working knowledge of enrollment and billing functions and FACETS system.
  • Must be able to identify compliance issues and complex business needs, develop solutions and resolve problems.
  • Must be able to coordinate with other internal departments as part of Triage Team to ensure that all required customer information is gathered comprehensively for all internal parties involved as early in the process as possible. Consolidate and communicate data requests back to the Group Leader.
  • Must have working knowledge of relevant software (e.g., MS Word, Excel, Outlook, etc.) and related software as well as other corporate programs and applications and the ability to learn new systems.
  • Must have thorough knowledge to apply company policies and procedures, company guidelines, state and federal laws and mandates (e.g., HIPPA, COBRA, PPACA, etc.) to ensure information is current and accurate.
  • Must demonstrate verbal and communication skills with the ability to interpret and communicate information with tact, diplomacy, patience and professionalism.
  • Must be able to prioritize multiple responsibilities, make decisions, find solutions and work independently in order to meet aggressive deadlines, and adapt to a fast-paced, changing environment.
  • Able to cohesively work in a team environment to ensure efficient and effective completion of all tasks for assigned groups.
  • Must have strong organizational and analytical abilities and effective interpersonal skills. Must be able to recognize inconsistencies and gaps in business processes and take appropriate actions.
  • Must possess a positive attitude which embraces customer-centric behavior, organizational cultural beliefs, company values as well as divisional requirements including efficiency, accuracy, productivity, and/or work schedule and confidentiality of information. Must be flexible to shift priorities as needed to cover multiple tasks in the process as directed by the Supervisor.
  • Must have working knowledge about plan products, company initiatives and other operational changes affecting the department.
  • Must be punctual and have regular attendance.
  • Must be able to work overtime during peak enrollment and renewal season.
Licenses and Certifications
  • None Required


ACCOUNTABILITIES AND ESSENTIAL FUNCTIONS
  • Duties of an Enrollment and Billing Specialist I and II
  • Serve as the subject matter expert with thorough knowledge of enrollment and billing processes including company policies and procedures, compliance guidelines, and state and federal laws and mandates (e.g., HIPPA, COBRA, PPACA, etc.). Work with Legal, DOI, and Compliance Specialists to ensure issues/cases that come form DOI are submitted in a timely manner.
  • Coordinate with Underwriting, Marketing, and Enrollment as part of the Triage team to effectively collect all required information as early in the process and minimize hand-offs and loop backs to customers and other parties for additional information s well as streamline the lockout process.
  • Serves as the point of contact for high priority inquiries and complaints to expedite the research and resolution accurately and in a time manner.
  • Coordinate internal or external fact-gathering meetings for issue resolution as needed and take minutes of the meeting to present to management.
  • Maintain working relationships with internal stakeholders and customers. This may include on-site visits and travel.
  • Calculate and process refunds, along with process the reinstatements and generate letters.
  • Analyze internal and external reports.
  • Ensure processing of reconciliation to maintain accurate policy records. Process premium-related charges, terminations/cancellations, and/or issues.
  • Perform reconciliations and audits.
  • Meet quality/production standards as determined by leadership
  • Perform self-audit and peer-audit procedures and complete related quality control documents and work management processes. Account for policies and procedures including compliance with state, federal, and departmental policies. Resolve all enrollment and invoice billing issues.
  • Identify inefficient or ineffective processes and offer process improvement plans.
  • Comply with all laws and regulations associated with duties and responsibilities
Additional Accountabilities and Essential Functions
The Physical Demands described here are representative of those that must be met by an employee to successfully perform the Accountabilities and Essential Functions of the job. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential functions
  • Perform other job-related duties as assigned, within your scope of responsibilities.
  • Job duties are performed in a normal and clean office environment with normal noise levels.
  • Work is predominately done while standing or sitting.
  • The ability to comprehend, document, calculate, visualize, and analyze are required.


An Equal Opportunity Employer

All BCBSLA EMPLOYEES please apply through Workday Careers.

PLEASE USE A WEB BROWSER OTHER THAN INTERNET EXPLORER IF YOU ENCOUNTER ISSUES (CHROME, FIREFOX, SAFARI)

Additional Information

Please be sure to monitor your email frequently for communications you may receive during the recruiting process. Due to the high volume of applications we receive, only those most qualified will be contacted. To monitor the status of your application, please visit the "My Applications" section in the Candidate Home section of your Workday account.

If you are an individual with a disability and require a reasonable accommodation to complete an application, please contact recruiting@bcbsla.com for assistance.

In support of our mission to improve the health and lives of Louisianians, Blue Cross encourages the good health of its employees and visitors. We want to ensure that our employees have a work environment that will optimize personal health and well-being. Due to the acknowledged hazards from exposure to environmental tobacco smoke, and in order to promote good health, our company properties are smoke and tobacco free.

Blue Cross and Blue Shield of Louisiana performs background and pre-employment drug screening after an offer has been extended and prior to hire for all positions. As part of this process records may be verified and information checked with agencies including but not limited to the Social Security Administration, criminal courts, federal, state, and county repositories of criminal records, Department of Motor Vehicles and credit bureaus. Pursuant with sec 1033 of the Violent Crime Control and Law Enforcement Act of 1994, individuals who have been convicted of a felony crime involving dishonesty or breach of trust are prohibited from working in the insurance industry unless they obtain written consent from their state insurance commissioner.

Additionally, Blue Cross and Blue Shield of Louisiana is a Drug Free Workplace. A pre-employment drug screen will be required and any offer is contingent upon satisfactory drug testing results.

  • Medical Billing Specialist

    4 weeks ago

    Baton Rouge, Louisiana, United States Lofton Staffing & Security Full time

    Lofton Staffing & Security is seeking a skilled Medical Billing Specialist to join their team at a prominent eye specialist center. As a certified medical billing specialist, you will be responsible for ensuring accurate and timely billing for patients receiving eye treatments and surgeries.The ideal candidate will have a minimum of 3 years experience in...

  • Benefits Enrollment Specialist

    4 weeks ago

    Baton Rouge, Louisiana, United States Alera Group, Inc. Full time

    Overview:Alera Group, Inc. is seeking a skilled Benefits Enrollment Specialist to join our Client Services Team. As a Benefits Enrollment Specialist, you will play a crucial role in educating and enrolling employees in their company benefit plans, assisting employees in filing supplemental insurance claims, and providing benefits administration support to...

  • Medical Billing Specialist

    4 weeks ago

    Baton Rouge, United States Robert Half Full time

    Job DescriptionJob DescriptionWe are in search of a Medical Billing Specialist for our client in Baton Rouge, Louisiana. This role offers a long-term contract employment opportunity in the healthcare industry. As a Medical Billing Specialist, you will be tasked with managing billing functions, maintaining accurate records, and handling customer inquiries....

  • LHRO Billing Specialist

    4 weeks ago

    Baton Rouge, Louisiana, United States LA Health and Rehab, Inc. Full time

    Job Title: LHRO Billing SpecialistJob Summary:LA Health and Rehab, Inc. is seeking a skilled Billing Specialist to join our team. The successful candidate will be responsible for performing various tasks to maintain smooth billing operations.Key Responsibilities:Basic medical coding and third-party operating procedures.Basic accounting knowledge with...

  • Medical Billing Specialist Opportunity

    4 weeks ago

    Baton Rouge, Louisiana, United States Lofton Staffing & Security Full time

    Medical Billing Specialist OpportunityWe are seeking a certified medical billing specialist to join our team at Lofton Staffing & Security. The ideal candidate will have a minimum of 3 years experience in medical billing and be able to catch all insurance questions on the front end.Requirements:Minimum 3 years experience in medical billingJob Type:Temp to...

  • Medical Billing Specialist

    4 weeks ago

    Baton Rouge, Louisiana, United States COMPREHENSIVE PAIN MANAGEMENT Full time

    Job SummaryWe are seeking a highly skilled Medical Billing Specialist to join our team at Comprehensive Pain Management. The ideal candidate will have experience in medical billing and collections, with a strong focus on working with patient and insurance balances, denials, and rejections.Responsibilities include:Processing claims and working with delinquent...

  • Medical Billing Specialist

    2 weeks ago

    Baton Rouge, United States Robert Half Full time

    Job DescriptionJob DescriptionWe are offering a long-term contract employment opportunity for a Medical Billing Specialist with our client in Baton Rouge, Louisiana. This role operates within the healthcare industry and involves leveraging various skills to ensure efficient and accurate medical billing processes. The workplace environment is dynamic, with a...

  • Medical Billing Specialist

    4 weeks ago

    Baton Rouge, Louisiana, United States Louisiana State University Healthcare Network: New Orleans Full time

    The role of a Medical Billing Specialist at the Louisiana State University Healthcare Network: New Orleans involves overseeing all aspects of patient payment processing in the Oral and Maxillofacial Surgery Clinic.Responsibilities include reviewing, researching, coding, and generating third-party billing for a medical facility. This includes filing and...

  • Claims Specialist III

    1 month ago

    Baton Rouge, Louisiana, United States Blue Cross and Blue Shield of Louisiana Full time

    Job SummaryWe are seeking a highly skilled Claims Specialist III to join our team at Blue Cross and Blue Shield of Louisiana. This role is responsible for processing complex claims, analyzing data, and communicating with internal and external stakeholders to ensure accurate and timely claims processing.Key ResponsibilitiesProcess complex claims, including...

  • Electronic Billing Specialist/Book-keeping Assistant

    4 weeks ago

    Baton Rouge, Louisiana, United States LONG LAW FIRM, LLP Full time

    Job DescriptionLong Law Firm, LLP is seeking a part-time Electronic Billing Specialist and Book-keeping Assistant to join their team in Baton Rouge. The ideal candidate will have a strong background in professional services and excellent organizational skills.Responsibilities:Coordinating with accounting to review pre-bills and ensure timely submission of...

  • Provider Enrollment Specialist

    4 months ago

    Baton Rouge, United States Baton Rouge General Full time

    Description This position will build and nurture positive relationships with Network providers and members by delivering high quality service through regular engagement.Routinely collects, verifies, and reports all provider demographic changes, additions, deletions, or corrections for provider enrollment and credentialing.Manages member inquiries regarding...

  • Medical Billing Coordinator

    4 weeks ago

    Baton Rouge, Louisiana, United States Amedisys, Inc. Full time

    OverviewAmedisys, a leading home health and hospice company, is seeking a skilled Medical Billing Coordinator to join our team. As a key member of our operations team, you will play a critical role in ensuring accurate and timely medical billing and reimbursement.ResponsibilitiesKnowledge of medical billing guidelines and criteria for reimbursement,...

  • Reporting Quality Control Specialist III

    4 weeks ago

    Baton Rouge, Louisiana, United States Montrose Environmental Group, Inc. Full time

    About MontroseMontrose is a global environmental services provider offering environmental planning and permitting, measurement and analytical services, and environmental resiliency and sustainability solutions. Our team of qualified engineers, scientists, technicians, associates, and policy experts are proud of our collective expertise and the collaborative...

  • Care Specialist

    4 weeks ago

    Baton Rouge, Louisiana, United States Upward Health Full time

    About the RoleCare Specialist - Patient AdvocateUpward Health is seeking a dedicated Care Specialist to join our team. As a Care Specialist, you will play a crucial role in delivering high-quality care to our patients. Your responsibilities will include conducting direct outreach to patients, enrolling them into our program, and collecting key data about...

  • Insurance Specialist

    1 month ago

    Baton Rouge, Louisiana, United States Lofton Staffing & Security Full time

    Job Title: Insurance/Billing SpecialistJob Summary:We are seeking a highly skilled and detail-oriented Insurance/Billing Specialist to join our team at Lofton Staffing & Security. As an Insurance/Billing Specialist, you will be responsible for overseeing patients' accounts, collecting balances, and maintaining a high level of insurance expertise.Key...

  • Administrative Support Specialist

    4 weeks ago

    Baton Rouge, Louisiana, United States Keogh, Cox and Wilson, Ltd. Full time

    Job DescriptionAs an Administrative Support Specialist at Keogh Cox, you will be responsible for providing exceptional support to our attorneys and administration team. Your duties will include billing and time entry, data entry, ordering supplies, and coordinating couriers and runners. You must be able to multitask and have excellent organizational skills....

  • Credentialing Manager

    1 month ago

    Baton Rouge, Louisiana, United States Louisiana Primary Care Association Full time

    Credentialing Manager Job DescriptionThe Louisiana Primary Care Association is seeking a highly skilled Credentialing Manager to oversee the successful operations of the credentialing program of the Louisiana Primary Care Accountable Care Organization. This is a full-time exempt position that reports to the Director of Managed Care and Network...

  • Business Operations Specialist

    4 weeks ago

    Baton Rouge, Louisiana, United States COMPREHENSIVE PAIN MANAGEMENT Full time

    We are seeking a highly skilled Business Office Specialist to join our team at Comprehensive Pain Management. The ideal candidate will have a strong understanding of medical terminology and be able to analyze denial data to identify frequent root causes of denials.Key Responsibilities:Research and analyze denial data to identify frequent root causes of...

  • Administrative Support Specialist

    1 month ago

    Baton Rouge, Louisiana, United States JBolt Electrical Full time

    Job SummarySeeking a highly organized and detail-oriented Administrative Support Specialist to join our team at JBolt Electrical. The ideal candidate will have excellent communication skills and a professional appearance.Key ResponsibilitiesAnswering phones, emails, and scheduling service callsProficient in Microsoft Office, Adobe, and QuickBooksStrong...

  • Healthcare Revenue Cycle Specialist

    1 month ago

    Baton Rouge, Louisiana, United States Pathology Group of Louisiana Full time

    Job Summary:We are seeking a highly skilled and detail-oriented Healthcare Revenue Cycle Specialist to join our team at Pathology Group of Louisiana. As a key member of our revenue cycle team, you will be responsible for collecting on outstanding claims for assigned payors, researching denials and refilling corrected claims, and monitoring reimbursement for...