Enrollment & Billing Operations Specialist

Fallon Community Health Plan, Inc.; Worcester (MA); On-site; USD 28,929 - 39,950; Full time

Job summary

Fallon Health seeks an Eligibility and Revenue Operations Representative to support enrollment and billing for Medicare and related products. You will ensure timely data entry, maintain system integrity, and collaborate with multiple departments to meet regulatory requirements.

The role emphasizes accuracy, speed, and adherence to internal SLAs, with responsibilities spanning data entry, payment processing, and issue resolution in a fast-paced environment.

Qualifications

• Bachelor’s Degree preferred.
• Experience in health care or managed care is desirable.
• Strong communication and organizational skills required.

Responsibilities

• Provide enrollment and billing support for Medicare Advantage, Medicare Supplement, NaviCare, Summit Elder Care, Fallon Health Weinberg.
• Enter and maintain eligibility and premium records in core systems.
• Analyze and reconcile receivables balance for different products to ensure accuracy.
• Maintain data integrity and compliance with CMS/EOHHS regulations.

Skills

Excellent communication skills

Customer service experience

Strong analytical and problem-solving

Education

Bachelor’s Degree preferred

Tools

MS Excel

MS Word

MS Access

Job description

Fallon Health seeks an Eligibility and Revenue Operations Representative to support enrollment and billing for Medicare and related products. You will ensure timely data entry, maintain system integrity, and collaborate with multiple departments to meet regulatory requirements.

The role emphasizes accuracy, speed, and adherence to internal SLAs, with responsibilities spanning data entry, payment processing, and issue resolution in a fast-paced environment.