Membership Accounting Analyst (Billing)

Helpware; Cebu City; On-site; PHP 334,800 - 580,320; Full time

Job summary

Doist in Cebu City is seeking a Membership Accounting Analyst to resolve discrepancies in Enrollment, Billing and Reconciliation processes. The role reviews documentation, processes queues and corrects errors while identifying trends.

You will handle CMS-related requirements, HIPAA compliance, and communications with customers. Requires high school diploma and 2 years in health plan operations; associates preferred.

Qualifications

• 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.
• HIPAA regulations awareness and compliance.
• Data entry and typing skills.
• Ability to handle stressful situations with empathy.
• Strong interpersonal and collaboration skills.

Responsibilities

• Process enrollment, billing, and reconciliation queue items accurately and promptly.
• Review incomplete enrollment applications and corrections for CMS submission.
• Review LEP attestations and OHI verification; correct errors as needed.
• Prepare retro processing packets for CMS RPC Billing Processing.
• Identify and post customer payments not automatically applied.
• Respond to billing-related correspondence and customer inquiries.
• Investigate returned checks, rejected ACH and credit card transactions.
• Handle automated premium payment requests by credit card or ACH.
• Process premium refunds per policy and SLA.
• CMS Enrollment Data Validation file preparation and submissions.

Skills

Analytical skills

Communication

Problem solving

Teamwork

Data entry

Typing

HIPAA knowledge

Customer service

Time management

Interpersonal skills

Education

High school diploma

Associate degree or higher preferred

Tools

CMS

Job description

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) guidanceConform with and abide by all regulations, policies, work procedures and instructionsMeet CMS guidelines and client Service Level Agreement (SLA) requirements through the proper handling of transactionsPerform outbound calls to customers or other entities as permitted to complete processing of enrollment, disenrollment, billing and or reconciliation transactionsMake appropriate system corrections and elevate transactions that are unable to be correctedPrepare reports as requested by managementPerform 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 processingExcellent analytical, decision-making, problem-solving, team, and time management skillsExcellent oral and written communication skillsDisplay positive demeanor, technical accuracy, and conformity to company policiesEnsure HIPAA regulations are maintained within the immediate environmentCommunicate with coworkers, management, staff, customers, and others in a courteous and professional mannerConform with and abide by all regulations, policies, work procedures and instructionsKnowledge of customer service best practices and principles.Excellent data entry and typing skills.Superior listening, verbal, and written communication skillsAbility 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