Healthcare Enrollment Processor Jobs

The Membership Accounting Analyst is responsible for the timely and accurate resolution of discrepancies identified in the Enrollment, Billing and/or Reconciliation processes. The analyst will review documentation, work items in queues and correct errors, identify trends and document resolutions.

Exciting opportunity to Work AT Home for a fast-growing healthcare organization

This will be a 7 month contract position with target start date of 8/9/2023

You will need to be within driving distance (60 miles) to our Miramar, FL campus to complete the background/drug screen and pick up Computer and Accessories.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Enrollment Processing

• Review and complete Other Health Insurance (OHI) verification and error correction
• Review and create retro processing packets to be submitted to the CMS Retro Processing Contractor (RPC)
• Review and complete Late Enrollment Penalty (LEP) Attestations
• Review incomplete and pending enrollment applications and disenrollment forms for correction and submission to Centers for Medicare & Medicaid Services (CMS)
• Process queue items, inter-departmental and customer requests timely and accurately

Billing Processing

• Review and approve/deny customer requests for premium refunds in accordance with established policies
• Process requests for automated premium payment via credit card or ACH withdrawal
• Respond to billing-related correspondence
• Identify and post customer payments not automatically applied by the appropriate system
• Monthly State Pharmaceutical Assistance Programs reconciliation
• Review and investigate returned checks, rejected ACH and credit card transactions

Reconciliation Processing

• Monthly review and preparation of the CMS Enrollment Data Validation file and submissions
• Researching and correcting errors, discrepancies, and rejected transactions received from:
• Monthly MMR, PWR, LIS History and LEP Reconciliation
• Daily and Monthly Pharmacy Benefit Manager (PBM)
• CMS on the Daily Transaction Reply Report (DTRR)
• Daily OHI/COB Rejections
• CMS Daily and Monthly Reconciliation queues

All Functions

• Conform with and abide by all regulations, policies, work procedures and instructions
• Make appropriate system corrections and escalate transactions that are unable to be corrected
• Perform outbound calls to customers or other entities as permitted to complete processing of enrollment, disenrollment, billing and or reconciliation transactions
• Meet CMS guidelines and client Service Level Agreement (SLA) requirements through the proper handling of transactions
• Working understanding of Centers for Medicare & Medicaid Services (CMS) guidance

EDUCATION AND EXPERIENCE

• Working knowledge of MSOffice (Word, Excel, Outlook)
• High school diploma required; Associates Degree or higher preferred
• Minimum 2 years Health Plan Operations experience including; Enrollment (preferred), Claims processing or Customer Service.

Job Type: Full-time, Temporary (7 month contract)

Salary: 17.40 per hour

Job Type: Contract

Benefits:

• Work from home

Schedule:

• Monday to Friday
• 8 hour shift
• Overtime as needed