Enrollment and Billing Representative II
PacificSource

Job Info

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Looking for a way to make an impact and help people?

Join PacificSource and help our members access quality, affordable care!

PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.

Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.

This position processes billing and enrollment updates for the Medicare and Medicaid line of business and maintains established procedures to process a multitude of transactions.

Essential Responsibilities:

• Efficiently and accurately completes the Essential Responsibilities of the Enrollment & Billing Representative I position.
• Process payment files and stage for the nightly batch; including but not limited to Lockbox.
• Reconcile Medicare accounts balances and determine accuracy by utilizing Excel.
• Review and analyze data for accuracy to provide billing to members. Input data on accounts receivable adjustments within strict billing timelines.
• Work the financial queue reports; including but not limited to delinquency, balance after termination, SSA members with balances and negative billed members.
• Draft and send delinquent letters to Medicare members.
• Receive and process Good Cause Reinstatement requests.
• Submit retroactive processing requests to the RPC and work with the CMS Regional Office as needed to review any enrollment discrepancies.
• Work all aspects of the Late Enrollment Penalty including but not limited to, initial letters, rescinding LEP, work LEP TRC's, and respond to all Maximus requests and decisions.
• Perform Upgrade Testing for the EAM and Facets systems utilized by the Enrollment and Billing department.
• Run and work the daily DTRR's including annual LIS Rider letters.
• Run and work daily MMS, XMS, EAM to Facets Validation and all aspects of the ID Card & Packet Timeliness Reports.
• Request Information from the beneficiary when enrollment forms are incomplete and process denial of enrollment within CMS compliance guidelines.
• Medicare enrollment commissions using the Onbase and Facets systems.
• Process all voluntary and involuntary disenrollment's within CMS compliance guidelines.
• Create and maintain Medicare and Medicaid department procedures.
• Work the Medicare Dual report by contacting the state DHS workers to verify eligibility and confirm enrollments and disenrollment's in the CCOA/CCOB.
• Work the Medicaid EMS Pended transaction fallout daily.
• Respond to all emails in the Medicaid Inbox including communicating with the state to verify eligibility and updating Facets eligibility as necessary.
• Process daily returned mail, making any related changes in EAM & Facets contacting the member if needed, and resending documents or processing as required by CMS.

Supporting Responsibilities:

• Back up Enrollment & Billing Representative I, as needed.
• Follow company and department policies.
• Meet department and company performance and attendance expectations.
• Provide backup support for other members of the enrollment team.
• Support and participate in continuous improvement initiatives.
• Maintain professional, service oriented relationships.
• Ability to judge severity of problems and need to escalate to management as necessary.
• Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
• Perform other duties as assigned.

Work Experience: Minimum of 4 years of administrative experience with at least 1 year in health insurance billing experience required. Demonstrated ability to conduct detailed research, collect data and review system reports.

Education, Certificates, Licenses: High School diploma or equivalent required. Associate's Degree preferred.

Knowledge: Ability to understand and interpret Federal and Oregon State laws and contract provisions. Advanced proficiency in Microsoft Office Applications. Excel experience to include formulas, sorts, and filters. Requires the ability to articulate problem statements, collect data and establish facts. Demonstrated organizational and time management skills.

Competencies:

Building Customer Loyalty

Building Strategic Work Relationships

Contributing to Team Success

Planning and Organizing

Continuous Improvement

Adaptability

Building Trust

Work Standards

Environment: Work inside in a general office setting with ergonomically configured equipment.

Skills:
Accountability, Communication, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork

Our Values

We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:

• We are committed to doing the right thing.
• We are one team working toward a common goal.
• We are each responsible for customer service.
• We practice open communication at all levels of the company to foster individual, team and company growth.
• We actively participate in efforts to improve our many communities-internally and externally.
• We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
• We encourage creativity, innovation, and the pursuit of excellence.

Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.

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