Analyst, Premium Reconciliation & Billing

Knowledge/Skills/Abilities

• Assists in resolution of escalated premium issues with Appeals and Grievances team.
• Investigates and resolves discrepancies between the expected premium billed and the premium received.
• Ensures all required financial SOX controls are tracked, monitored and maintained within quality and timeliness measures
• Performs month-end invoicing and accuracy audits.
• Consider downstream and upstream impacts related to other departments due to Enrollment related changes and coordinate with Center of Excellence team as needed.
• Assist in the development and testing of external vendor systems to ensure CMS processing guidelines are met within the designated time frames.
• Support Member Service representatives to help them resolve member inquiries.
• Tracks and follows up on any exceptions and/or discrepancies with enrollment and/or revenue amounts expected from CMS and/or the State agencies/exchanges to achieve accurate enrollment reconciliation and maximum premiums collected and/or recovered
• Provide Medicare Part D premium invoicing to include premium bill issuance, payment allocation and reconciliation with Accounting and Finance Dept.
• Performs enrollment reconciliation processes for all lines of business (Medicaid, Marketplace, Medicare) in accordance with established policies and procedures.
• Develops and maintains enrollment and financial scorecards and work plans to ensure goals are met and/or exceeded
• Collaborates with Enrollment team to resolve eligibility issues affecting premium billing.
• Processes enrollee invoices and premium reconciliation for billed members.
• Assist Supervisor/Manager in billing and reconciliation to ensure compliance with Medicare regulations.
• Generate monthly reporting of enrollment related statistics and various database reports.

Job Qualifications
REQUIRED EXPERIENCE:
3+ years of Member Billing /Reconcilation
Preferred Experience
Healthcare industry experience, with emphasis on enrollment, member billing, and premium reconciliation preferred.
Physical Demands
Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $18.04 - $35.17 an hour*

• Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.