Premium Billing Specialist

Company: TalentBoost (Point32Health)
Location: Natick
Posted on: November 26, 2022

Job Description:

Under the supervision of the THPMP Premium Billing Manager, this individual must be able to consistently and accurately review, analyze, and reconcile all employer group accounts receivable balances on a monthly basis. The Premium Billing Senior Coordinator must independently work with the employer group contacts to establish solid business relationships, resolve discrepancies, and receive appropriate payments within the required timeframe.
The Premium Billing Senior Coordinator is responsible for setting up all employer groups and ensuring they are paying properly and being billed properly. This position will also handle the more complicated member adjustments including members with SSA and LEP/LIS. He/she will actively participate in project initiatives, sharing subject matter expertise to achieve business goals. The resource will ensure compliance with all CMS & State regulations and internal department processes while fully supporting the expansion of production offerings and process changes as a result of such.
He/she must be able to proactively escalate issues, identify areas of process improvement, and demonstrate positive and strong collaboration both within the Premium Billing Team, and across all THPMP departments. -KEY RESPONSIBILITIES/ESSENTIAL FUNCTIONSEmployer Group Setup and Reconciliation

• Setup new Employer Groups
• Enter group information provided and create necessary rate screens including assigning the appropriate Pharmacy Group Code
• Perform quality check on setup and provide written approval of setup to Internal Audit
• Monthly Reconciliation of Employer Group invoices and payments
• Document discrepancies and send to Employer Group by deadline
• Verify all delinquent Employer Groups, update the delinquency tracker for Sales, term groups who fail to pay premiums
• Answer calls on the Group LineMember Adjustments
  • Review and process adjustments for accounts of members who pay via SSA or have LEP/LIS
  • Respond to actiongram requests from CR on these members by the SLA
  • Work with Premium Billing Analyst to ensure all adjustments are processed timelyProjects/Other Assignments
    • Participate in small to medium projects and workgroups
    • Quality check own work and that of others within the department
    • Meet production standards for quality and quantity
    • Other duties as assignedCompliance
      • Learn and apply regulatory changes to daily production tasks (Late Enrollment Penalty/Low Income Subsidy/Employer Group Downgrade)
      • Actively participate in Corporate Compliance and CMS training (CBTs/Instructor Led Training) within established timeframes
      • Review and revise workflows in Support Point as changes to processes happen
      • Ensure internal procedures and CMS/State requirements are met -Qualifications - what you need to perform the jobEDUCATION:
        • High School graduate; Associates degree or some college preferredEXPERIENCE:
          • Minimum two to four years related business experience, including financial/accounting/bookkeepingSKILL REQUIREMENTS:
            • Strong analytical and critical thinking skills
            • Ability to perform thorough research, documenting results
            • Ability to proficiently navigate internal and external programs/applications
            • Time management skills and ability to multi-task
            • Demonstrate flexibility in times of business and organizational change
            • Demonstrate professional demeanor at all times
            • Experience with Excel, Access, and Lotus NotesWORKING CONDITIONS AND ADDITIONAL REQUIREMENTS:
              • Fast-paced office environment handling multiple demands. Requires the individual be organized and able to prioritize. Must be able to work independently and in a team environment. May require occasional evening or weekend hours as dictated by the needs of the business.CONFIDENTIAL DATA: All information (written, verbal, electronic, etc.) that an employee encounters while working at Tufts Health Plan is considered confidential. Exposed to and required to deal with highly confidential and sensitive material and must adhere to corporate compliance policy, department guidelines/policies and all applicable laws and regulations at all times. -Commitment to Diversity, Equity & InclusionPoint32Health is committed to making diversity, equity, and inclusion part of everything we do-from product design to the workforce driving that innovation. Our DEI strategy is deeply connected to our core values and will evolve as the changing nature of work shifts. Programming, events, and an inclusion infrastructure play a role in how we spread cultural awareness, train people leaders on engaging with their teams and provide parameters on how to recruit and retain talented and dynamic talent. We welcome all applicants and qualified individuals, who will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. -COVID PolicyPlease note: As of January 18, 2022, all employees - including remote employees - must be fully vaccinated. This position will require the successful candidate to show proof of full vaccination against COVID-19. Point32Health is an equal opportunity employer, and will consider reasonable accommodation to those individuals who are unable to be vaccinated consistent with federal, state, and local law. -About the CompanyPoint32Health is a leading health and wellbeing organization, delivering an ever-better personalized health care experience to everyone in our communities. At Point32Health, we are building on the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care, where we leverage our experience and expertise to help people find their version of healthier living through a broad range of health plans and tools that make navigating health and wellbeing easier.We enjoy the important work we do every day in service to our members, partners, colleagues and communities.This job has been posted by TalentBoost on behalf of Point32Health. TalentBoost is committed to the fundamental principle of equal opportunity and equal treatment for every prospective and current employee. It is the policy of TalentBoost not to discriminate based on race, color, national or ethnic origin, ancestry, age, religion, creed, disability, sex and gender, sexual orientation, gender identity and/or expression, military or veteran status, or any other characteristic protected under applicable federal, state or local law.Req ID: R5284

Keywords: TalentBoost (Point32Health), Boston , Premium Billing Specialist, Accounting, Auditing , Natick, Massachusetts