Helpware is a technology-driven company with offices in the USA, Ukraine, Mexico, and the Philippines which provide Customer Experience & Operational Support for modern companies. Our team of professionals is driven by the purpose of providing best-in-class value-adding services to our partners by leveraging our empowered teams, innovative solutions, and technologies.
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.
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.
- 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
Requirements
- High school diploma required; Associates Degree or higher preferred.
- Minimum 2 years Health Plan Operations experience including; Customer Service, Enrollment, and or Claims processing
- Excellent analytical, decision-making, problem-solving, team, and time management skills
- Excellent oral and written communication skills
- Display positive demeanor, technical accuracy, and conformity to company policies
- Ensure HIPAA regulations are maintained within the immediate environment
- Communicate with coworkers, management, staff, customers, and others in a courteous and professional manner
- Conform with and abide by all regulations, policies, work procedures and instructions
- Knowledge of customer service best practices and principles.
- Excellent data entry and typing skills.
- Superior listening, verbal, and written communication skills
- Ability to handle stressful situations appropriately, while demonstrating empathy.
- Resourceful, great at solving unstructured problems with little to no supervision in a fast-paced, high stakes environment.
- Team Player: Demonstrates a strong ability to contribute to the business along with business unit team members and managers; establish collaborative relationships with peers.
- Possess strong interpersonal skills and the ability to establish, develop, and maintain business relationships.
- Excellent written and verbal skills