TM-Enrollment & Billing

Job Summary

Serve as a senior specialist in enrollment and billing within a hybrid work model applying deep knowledge of HIPAA compliance benefits open enrollment processes and payer and provider operations. Ensure accurate timely and compliant member enrollment and billing activities in a night shift environment supporting a seamless experience for health plan members and partners.

Responsibilities

• Coordinate complex member enrollment and billing activities across multiple payer and provider systems to ensure timely and accurate processing of all transactions in a night shift setting.
• Ensure strict adherence to HIPAA regulations when handling enrollment data and billing records so that all protected health information remains secure and fully compliant.
• Analyze benefits open enrollment files and eligibility feeds to validate member elections identify discrepancies and recommend corrective actions that prevent downstream billing issues.
• Design and refine enrollment and billing workflows that reduce manual effort minimize defects and accelerate cycle time while maintaining high standards of quality and compliance.
• Collaborate with payer and provider stakeholders to clarify benefits rules eligibility criteria and coverage configurations so that enrollment data aligns with contractual obligations.
• Perform root cause analysis on recurring enrollment and billing defects and develop sustainable remediation plans that reduce rework and improve customer satisfaction.
• Create and maintain detailed documentation for enrollment rules billing logic file formats and exception handling so that project teams and operations staff can execute processes consistently.
• Coordinate with technology teams to translate business requirements for HIPAA compliant enrollment and billing solutions into clear functional specifications and acceptance criteria.
• Validate inbound and outbound enrollment and billing files using test cases that reflect real world payer and provider scenarios to confirm system reliability and data integrity.
• Provide subject matter guidance during production incidents related to enrollment and billing by investigating data flows and recommending safe mitigation steps.
• Monitor key performance indicators for enrollment accuracy billing timeliness and error rates and propose data driven improvements that align with organizational objectives.
• Guide junior analysts by sharing domain insights on payer and provider operations explaining complex benefit structures and demonstrating best practices in enrollment processing.
• Engage with business partners to explain the impact of benefit design changes on enrollment and billing timelines so that operational expectations are realistic and achievable.

Qualifications

• Demonstrate extensive experience working with HIPAA standards in healthcare enrollment and billing contexts including handling electronic data with a focus on privacy and security.
• Exhibit strong practical expertise in benefits open enrollment processes including eligibility determination coverage elections and downstream billing implications.
• Bring proven domain experience across both payer and provider environments including familiarity with health plan structures provider networks and claim lifecycle touchpoints.
• Apply advanced analytical skills to interpret complex enrollment and billing data sets using tools such as spreadsheets or reporting platforms to identify and resolve anomalies.
• Use excellent verbal and written communication skills to collaborate with cross functional stakeholders in a hybrid work model and clearly articulate technical and business concepts.
• Manage work independently during night shifts prioritizing tasks effectively and maintaining accuracy and focus without the need for constant oversight.
• Leverage prior experience of eight to nine years in healthcare enrollment billing or related operations to handle complex cases and guide peers in resolving challenging scenarios.