Membership Accounting Advocate
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Description
Job Title: Membership Accounting Analyst
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.
Essential duties and 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 received from:
- CMS on the Daily Transaction Reply Report (DTRR)
- CMS Daily and Monthly Reconciliation queues
- Daily and Monthly Pharmacy Benefit Manager (PBM)
- Monthly MMR, PWR, LIS History and LEP Reconciliation
- Daily OHI/COB Rejections
- Monthly review and preparation of the CMS Enrollment Data Validation file and submissions
All Functions
- Working understanding of Centers for Medicare & Medicaid Services (CMS) guidance
- Conform with and abide by all regulations, policies, work procedures and instructions
- Meet CMS guidelines and client Service Level Agreement (SLA) requirements through the proper handling of transactions
- Perform outbound calls to customers or other entities as permitted to complete processing of enrollment, disenrollment, billing and or reconciliation transactions
- Make appropriate system corrections and escalate transactions that are unable to be corrected
- Prepare reports as requested by management
- Perform other duties and responsibilities as required
Education and Experience:
- High school diploma required; Associates Degree or higher preferred
- Minimum 2 years Health Plan Operations experience including; Enrollment (preferred), Claims processing or Customer Service.
- Working knowledge of MSOffice (Word, Excel, Outlook)