Premium Billing Analyst: Data Integrity & Compliance

martin; Portland (ME); On-site; USD 32,000 - 39,000; Full time

Job summary

Martin's Point Health Care is seeking a Premium Billing Reconciliation Specialist to oversee member profile management and health plan data reconciliation. You will ensure compliance with Medicare, DOD, and Bureau of Insurance enrollment billing and payment data reconciliation.

The role requires at least 2 years in health plan enrollment/billing, strong Excel skills, and the ability to work in a fast-paced environment. A flexible schedule including weekends may be required.

Qualifications

• Education: High School Diploma required.
• Post-Secondary Education preferred.
• 2+ years of health plan membership enrollment and/or billing processing experience.
• Experience with plan enrollment and supporting systems.
• Experience working with Managed Care eligibility processes and systems, preferably with Government health care programs.
• Exceptional analytical skills.
• Proficient knowledge of Microsoft Excel is required.
• Must have excellent communication skills as this position interacts with individuals outside the organization.
• Detail oriented with excellent follow up skills.
• Demonstrates an understanding of and alignment with Martin's Point Values.
• Must be detail and deadline oriented, flexible, and able to function effectively in a fast-paced environment.
• Must be able to work a flexible schedule, including weekends and holidays when necessary.

Responsibilities

• Maintains expertise in premium billing knowledge and serves as a learning resource for team members.
• Collaborates with Accounting and Finance to respond to member premium requests and issues.
• Meets or exceeds department accuracy and productivity goals.
• Identifies process gaps and drives improvement initiatives.
• Assists in developing and distributing standard work and ad hoc reports.
• Supports all Premium Billing Specialist tasks and coverage as needed.
• Performs quality assurance reviews on reporting and data.
• Performs data validation for daily, weekly, monthly activities.
• Assists with audit documentation and corrective action plans.
• Manages account investigation and data quality in the premium billing system.
• Processes member premium refunds and corrections.
• Resolves escalated inquiries from members and stakeholders.
• Posts daily payments and manages electronic payment processes.
• Identifies defects and recommends solutions.
• Partners to manage overdue or underpaid accounts.
• Generates and manages member invoices as requested.
• Performs other related duties and timely billing.

Skills

Analytical skills

Excellent communication

Detail oriented

Deadline oriented

Education

High School Diploma

Post-Secondary Education

Tools

Microsoft Excel

Job description

Martin's Point Health Care is seeking a Premium Billing Reconciliation Specialist to oversee member profile management and health plan data reconciliation. You will ensure compliance with Medicare, DOD, and Bureau of Insurance enrollment billing and payment data reconciliation.

The role requires at least 2 years in health plan enrollment/billing, strong Excel skills, and the ability to work in a fast-paced environment. A flexible schedule including weekends may be required.