Job Opportunities API

Position Summary: 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. Responsibilities: Enrollment Processing • Process queue items, inter-departmental and customer requests timely and accurately. • Review incomplete and pending enrollment applications and disenrollment forms for correction and submission to Centers for Medicare & Medicaid Services (CMS) • Review and complete Late Enrollment Penalty (LEP) Attestations • 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) Billing Processing • Identify and post customer payments not automatically applied by the appropriate system • Respond to billing-related correspondence • Review and investigate returned checks, rejected ACH and credit card transactions • Process requests for automated premium payment via credit card or ACH withdrawal • Review and approve/deny customer requests for premium refunds in accordance with established policies. • Monthly State Pharmaceutical Assistance Programs reconciliation Reconciliation Processing • Researching and correcting errors, discrepancies, and rejected transactions. • Monthly review and preparation of the CMS Enrollment Data Validation file and submissions. All Functions: • Working understanding of Centers for Medicare & Medicaid Services (CMS) guidance • Conform with and abide by all regulations, policies, work procedures and instructions • Meet CMS guidelines and client Service Level Agreement (SLA) requirements through the proper handling of transactions • Perform outbound calls to customers or other entities as permitted to complete processing of enrollment, disenrollment, billing and or reconciliation transactions • Make appropriate system corrections and escalate transactions that are unable to be corrected • Prepare reports as requested by management • Perform other duties and responsibilities as required Requirements • High school diploma required; Associates Degree or higher preferred. • Minimum 2 years Health Plan Operations experience including; Customer Service, Enrollment, and or Claims processing • Excellent analytical, decision-making, problem-solving, team, and time management skills • Excellent oral and written communication skills • Display positive demeanor, technical accuracy, and conformity to company policies • Ensure HIPAA regulations are maintained within the immediate environment • Communicate with coworkers, management, staff, customers, and others in a courteous and professional manner • Conform with and abide by all regulations, policies, work procedures and instructions • Knowledge of customer service best practices and principles. • Excellent data entry and typing skills. • Superior listening, verbal, and written communication skills • Ability to handle stressful situations appropriately, while demonstrating empathy. • Resourceful, great at solving unstructured problems with little to no supervision in a fast-paced, high stakes environment. • Team Player: Demonstrates a strong ability to contribute to the business along with business unit team members and managers; establish collaborative relationships with peers. • Possess strong interpersonal skills and the ability to establish, develop, and maintain business relationships. • Excellent written and verbal skills