This position is responsible for the ability to understand and abide by Federal Centers for Medicare and Medicaid Services guidance.
Fast-paced environment with frequent priority changes.
Organization and follow-up abilities will be critical.
Policy and reconciles daily systemic eligibility discrepancies.
Responsibilities:
Reconciliation of all daily, weekly and monthly Medicare reports generated from CMS as well as researching where required.
Deadline sensitive information processing, including Quality Audit.
Review and analysis of reporting to dictate daily/weekly priorities.
Working within comprehensive understanding of several databases.
Directly respond or support a response that is rapid and professional to internal and external customers, not limited to Medicare Beneficiaries, Federal
Regulators, Executives and Congress persons.
Generating and ensuring compliance and accuracy of various types of member correspondence.
Reconciling eligibility discrepancies relying on your ability to arrive at a consistently compliant disposition after the analysis of information from several reference-guidance, Call Center notes, multiple databases, and telephone outreach.
Inventory control responsibility.
Identification and communication of processing performance opportunities.
Performs other duties assigned by management.
Demonstrates knowledge and understanding of the laws, regulations and policies that pertain to the organizational unit's business and conforms with these laws, regulations and policies in carrying out the accountabilities of the job.
Responsible for successful administration of the delinquency outreach program for assigned members who are not current in their premium payment
Responsible for review, reconciliation to member premium bills and financial accounts.
Qualifications:
High School diploma or GED required, Bachelor's degree from an accredited college or university preferred.
Requires a minimum of three (3) years’ experience in Health Insurance, or a related Medicare experience.
Knowledge:
Requires detailed knowledge of system development life cycle and implementation methodologies.
Requires excellent proficiency in structured query languages, analysis techniques and Access database.
Has played a key role in major company initiatives and demonstrated some leadership experience.
Has proven knowledge and experience with to translate CMS regulatory guidance.
Skills and Abilities:
Requires excellent written and oral communication skills.
Requires the ability to communicate in a clear and concise manner.
Require strong PC skills including spreadsheets and word documents.
Requires excellent organizational skills.
Requires working knowledge of programming, development, and technical architecture.
Requires conflict resolution and problem solving skills.