Enrollment and Billing Representative I

4 weeks ago

Bend, Oregon, United States PacificSource Full time
Make a Difference in Healthcare

PacificSource 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 changes.

Key Responsibilities:
  • Process daily returned mail, making any related changes in EAM & Facets, and contacting members as needed.
  • Manually create and send Out of Area letters to members who may have moved out of the service area.
  • Respond to inquiries received via phone calls, emails, etc., researching or providing information needed or making any necessary changes to member files.
  • Add or correct member data in our pharmacy vendor database.
  • Process all Medicare membership enrollment, plan changes, facilitated enrollments, and reinstatements.
  • Review the daily EAM Validation report and make corrections as necessary.
  • Process all Medicare membership cancellation of enrollments, cancellation of disenrollments, and death notifications.
  • Process the CMS Enrollment Data Verification monthly audit for address and enrollment updates.
  • Answer Queue Customer Service calls for Medicaid/Medicare members regarding eligibility.
  • Submit miscellaneous transactions to CMS daily as needed.
  • Respond to insurance verification requests for Medicare members.
  • Perform scanning and key wording of ROI's/POA's into Onbase for the Government line of business.
  • Load ROI/POA documentation into Facets.
  • Work the monthly P2P report for Accounts Payable Download CMS applications, upload electronic applications into EAM, save applications, and perform indexing of applications in Onbase.
  • Process all Medicare COB. Send COB letters to members, update Facets, and the COB database, and submit member information back to ECRS.
Requirements:
  • Minimum 2 years of administrative experience with at least 1 year in health insurance billing or related healthcare experience required.
  • Demonstrated ability to work efficiently and effectively with a high attention to detail.
  • Ability to understand and interpret Federal and Oregon State laws and contract provisions.
  • Proficiency in Microsoft Applications.
  • Demonstrated organizational and time management skills.
  • Requires keyboarding and 10-key skills.
  • Experience with problem-solving and ability to read system reports.
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:

The ideal candidate will be able to stoop and bend, sit and/or stand for extended periods of time while performing core job functions, and perform repetitive motions to include typing, sorting, and filing. Light lifting and carrying of files and business materials are also required. Ability to read and comprehend both written and spoken English, communicate clearly and effectively, and maintain professional, service-oriented relationships is essential.

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