Senior Specialist, Premium Reconciliation & Billing (Must Reside in WI)

Molina Healthcare; San Diego; Presencial; VES 450.000 - 675.000; Jornada completa

Descripción de la vacante

A leading healthcare company in Venezuela is looking for a billing specialist to manage enrollee invoices and premium reconciliations. This role involves direct support to Member Service representatives and requires strong organizational skills and experience in premium processes. Ideal candidates should have over three years of relevant experience and proficiency in MS Office. The role offers competitive benefits and a collaborative work environment.

Servicios

Competitive benefits package

Formación

• 3+ years of experience in Member Billing.
• Previous experience in the healthcare industry preferred.

Responsabilidades

• Process daily enrollee invoices and premium reconciliations.
• Guide Member Service representatives in member inquiries.
• Reconcile complex premiums from various sources.

Conocimientos

Time management

Organizational skills

Team-oriented

Communication skills

MS Office proficiency

SQL experience

Educación

High School diploma

Associates Degree or higher preferred

Descripción del empleo

Knowledge/Skills/Abilities

• Process daily enrollee's (Individual and family) invoices and premium reconciliation for Marketplace members.
• Reconcile premiums received from the individual subscriber or responsible party with the amount due for the healthcare program the member is enrolled.
• Guide and support Member Service representatives to help them resolve member inquiries related to healthcare premium.
• Assist in resolution for escalated premium issues with Appeals and Grievances team members.
• Guide and collaborates with enrollment team to resolve eligibility issues affecting premium billing.
• Generate billing data using the QNXT premium billing module to be sent to print and fulfillment vendor.
• Reconcile unallocated payments on a daily basis.
• Resolve orphan member payments on a daily basis.
• Reconcile monies received from the financial institution.
• Perform month-end invoicing and accuracy audits.
• Comply with all State/Regulatory requirements.
• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).
• Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers.

Under limited supervision, drives and supports reconciliation of premiums for members enrolled through the Healthcare Marketplace as a part of the Affordable Care Act (ACA). Reconciliation will be performed for more complex premiums received from members, state agencies and CMS. Team member will work closely with enrollment teams and offer guidance where premiums are directly impacted by enrollment discrepancies. Collaborate with and advises call center teams to maintain member satisfaction for this product. Work with financial institutions to ensure timely and accurate processing of payment received.

Qualifications

Marketplace, Commercial, or Medicare healthcare experience with premium billing and reconciliation.

Must have excellent time management and organizational skills.

Strong team-oriented individual.

Excellent communication with all levels of team.

Must have strong knowledge and experience in MS office products, minimally Outlook, Word and Excel.

Access or SQL experience is a plus.

Excellent verbal and written communication skills.

Ability to abide by Molina's policies.

Maintain regular attendance based on agreed-upon schedule.

Job Qualifications

Required Education

High School diploma required.

Required Experience

3+ years of Member Billing /R.

Required Licensure/Certification, Association

Marketplace, Commercial or Medicare Industry preferred.

Required Licensure/Certification: None

Preferred Education

Associates Degree or higher preferred.

Preferred Experience

Healthcare industry experience, with emphasis on enrollment, member billing, and premium reconciliation preferred.

Preferred Licensure/Certification, Association

None.

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.