Helpware is a technology-driven company with offices in the USA, Ukraine, Mexico, and the Philippines which provides 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 accuratelyReview 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) AttestationsReview and complete Other Health Insurance (OHI) verification and error correctionReview 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 systemRespond to billing-related correspondenceReview and investigate returned checks, rejected ACH and credit card transactionsProcess requests for automated premium payment via credit card or ACH withdrawal Review and approve/deny customer requests for premium refunds in accordance with established policiesMonthly 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) guidanceConform with and abide by all regulations, policies, work procedures and instructionsMeet CMS guidelines and client Service Level Agreement (SLA) requirements through the proper handling of transactionsPerform outbound calls to customers or other entities as permitted to complete processing of enrollment, disenrollment, billing and or reconciliation transactionsMake appropriate system corrections and escalate transactions that are unable to be correctedPrepare reports as requested by managementPerform 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 processingExcellent analytical, decision-making, problem-solving, team, and time management skillsExcellent oral and written communication skillsDisplay positive demeanor, technical accuracy, and conformity to company policiesEnsure HIPAA regulations are maintained within the immediate environmentCommunicate with coworkers, management, staff, customers, and others in a courteous and professional mannerConform with and abide by all regulations, policies, work procedures and instructionsKnowledge of customer service best practices and principles.Excellent data entry and typing skills.Superior listening, verbal, and written communication skillsAbility 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
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