FC
Billing Membership Analyst
First Connect
🇺🇸 United States
On-site
4 weeks ago
- Regulatory Compliance
- Excel
- CMS
4 weeks ago
Develops, implements, performs and reconciles transactions in our claims system and surrounding vendor systems while ensuring all regulatory compliance guidelines are followed and met. Researches and maintains knowledge of current and proposed legislation impacting enrollment, eligibility and premium billing functions, to ensure department compliance.
Minimum Qualifications: 1. Formal Education Required: a. High school diploma or equivalent 2. Experience & Training Required: a. One (1) year experience in eligibility processing, auditing of records and reports, moderately complex data processing and/or working knowledge of customer service/claims/eligibility software applications that support healthcare operations. Competencies and
Qualifications:
Microsoft Office: Access, Word and Excel at a basic level.
Ability to type 35 words per minute at a 95% accuracy rate*** c. Ability to communicate in a professional manner to a wide variety of audiences, including Senior Leadership.
Excellent proofreading skills.
Strong analytical skills to review data from a variety of sources in order to make recommendations/conclusions based on the outcomes.
Excellent attention to detail and strong troubleshooting skills.
Organize and manage time to accurately complete tasks within defined timeframes in a fast-paced, often-changing environment.
Maintain current knowledge of and comply with regulatory and business information.
Maintain confidentiality of member health and business information.
Independent judgement, decision making and problem solving.
Timely and accurate implementation of new and/or maintenance of existing enrollment and/or groups in the claims processing system.
Review enrollment files and work error reports in a timely and consistent manner. Respond and distribute inquiries from our member/provider portal and assigned email groups.
Investigate transactions rejected by CMS, FFM and other third-party vendors and take appropriate action in accordance of defined compliance guidelines.
Analyze data to identify deficiencies and eliminate compliance risk.
Perform outreach to prospective enrollees and/or employer groups as needed to confirm or clarify submitted enrollment information.
Assist with quality control auditing of files related to enrollment and reconciliation that are exchanged between SummaCare and third-party vendors and take appropriate action.
Provide exceptional, personalized service to all clients in person, by phone or electronically regarding information, questions and/or problems concerning eligibility and billing, enrollment status, coordination of benefits, primary care physician and address changes.
Handle all incoming phone calls on the Group/Broker support line and record all client inquiries and complaints via the document/workflow management system and route service forms to the appropriate area for resolution.
Batch all correspondence for scanning into the document management system.
Work as a team member to accomplish larger application goals and work independently with little supervision when completing assigned tasks or other responsibilities.
Develop and implement policies, procedures and systems aimed at ensuring eligibility and billing are in full compliance with regulatory requirements and standards. Job Description
Perform all job functions with integrity. Provide timely internal and external customer service in a professional, cooperative and respectful manner.
VivPost
Billing Membership Analyst · First Connect