Membership Accounting Analyst (Billing)

Helpware is a technology-driven company with offices in the USA, Ukraine, Mexico, and the Philippines which provide Customer Experience & Operational Support for modern companies. Our team of professionals is driven by the purpose of providing best-in-class value-adding services to our partners by leveraging our empowered teams, innovative solutions, and technologies.

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