Account Administration Representative

NALHE; San Diego (CA); On-site; USD 45,000 - 60,000; Full time

Job summary

NALHE is seeking a team member for the California Service Center to support membership accounting and contracts administration. Responsibilities include maintaining accurate billing records, ensuring timely responses to eligibility inquiries, and conducting detailed audits. Candidates should exhibit strong analytical skills and customer service experience.

The role involves collaboration with interdepartmental teams and external vendors to enhance operational efficiencies. This position aims to provide comprehensive support related to account maintenance and customer service, contributing to the overall objectives of the organization.

Qualifications

• Experience in customer service-related roles.
• Strong analytical skills for billing and account reconciliation.
• Familiarity with database management.

Responsibilities

• Maintain member data accurately and efficiently.
• Ensure correct billing and timely mailings.
• Support eligibility inquiries and resolve discrepancies.

Skills

Customer service

Billing and reconciliation

Database maintenance

Job description

Job Summary:

To work as a team member of the California Service Center (CSC) which is the Membership Accounting and Contracts Administration functions for the California Division. The overall objectives of this position is to perform the account maintenance, billing, reconciliation, reporting and customer service related activities. Duties also include performing database maintenance and research tasks to support the contracts administration, cash control operations and assignment of medical record numbers, to generate and distribute contracts and member I.D. cards, to provide facilities support and to enter documents into the workflow imaging system.

Essential Responsibilities:

• Identifying, researching and reconciling billing payments amounts to ensure accurate eligibility determination, payment, revenue and membership records.
• Setting up and maintaining member data including but not limited to processing enrollments, corrections, retroactivity adjustments and terminations.
• Supporting eligibility inquiries.
• Ensuring bills are correct and mailed timely.
• Interacting with purchaser benefit administrators to answer questions and explain Health Plan policy and contractual provisions related to membership and billing.
• Resolving related problems.
• Assisting Health Plan purchaser contacts and sales and service representatives in the sales process and the analysis and resolution of problems related to membership accounting.
• Conducting audits of purchasers with large payment variances, unallocated payments or other specified criteria.
• Resolving payment discrepancies and delinquencies.
• Ensuring purchasers compliance with Health Plan policies and contractual provisions.
• Preparing reports and managing purchaser correspondence.
• Receiving, entering data, reviewing, researching balancing, and applying daily purchaser deposits and sources from the bank in a timely and accurate fashion.
• Assisting with the production and distribution of payment-related reports required by purchasers and management, and by operating and maintaining printers and other related peripheral equipment.
• Supporting Medicare processing and reporting requirements.
• Ensuring that changes to contracts are quickly and accurately updated in the contract systems.
• Assisting with the production and distribution of contracts and related notices for new and renewing purchasers and individuals.
• Answering, researching, issuing and resolving problems related to medical records numbers (MRN) and performing any required follow up activities on a 24 hour per day, 7 day a week basis.
• Processing purchasers eligibility reported electronically by coordinating the exchange of media with groups and Information Services, resolving problems, maintaining and operating related equipment and maintaining supporting logs/records.
• Identifying, coding, batching, scanning and indexing documents for imaging.
• Providing office services support including but not limited to picking up, sorting and delivering mail, filing and retrieving documents, ordering and distributing office supplies, performing miscellaneous facilities maintenance tasks and providing photocopying and copier maintenance.
• Working with internal and external customers and vendors to resolve any issues related to support services activities.
• Collecting and monitoring productivity and customer service quality measures.
• Participating team-based projects and contributing to customer service and operations improvements initiatives.
• Assisting with training as required.
• Facilitating communications across all lines of business and with other Kaiser Permanente departments.
• Participating in purchasers performance evaluations and performance target setting activities.
• Perform other duties as they are assigned.