Enrollment and Billing Representative II
3 weeks ago
PacificSource is seeking a highly skilled Enrollment and Billing Representative II to join our team. As a key member of our operations team, you will be responsible for processing billing and enrollment updates for our Medicare and Medicaid line of business.
Key Responsibilities- Efficiently and accurately complete the essential responsibilities of the Enrollment & Billing Representative I position.
- Process payment files and stage for the nightly batch, including Lockbox.
- Reconcile Medicare accounts balances and determine accuracy using 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 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 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.
- 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.
- High School diploma or equivalent required. Associate's Degree preferred.
- 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.
- Building Customer Loyalty
- Building Strategic Work Relationships
- Contributing to Team Success
- Planning and Organizing
- Continuous Improvement
- Adaptability
- Building Trust
- Work Standards
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
- 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.
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.
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.
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