Temporary Premium Billing Reconciliation Specialist-2

Premium Billing Reconciliation Specialist

Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force of "people caring for people," Martin's Point employees are on a mission to transform our health care system while creating a healthier community. Martin's Point employees enjoy an organizational culture of trust and respect, where our values - taking care of ourselves and others, continuous learning, helping each other, and having fun - are brought to life every day. Join us and find out for yourself why Martin's Point has been certified as a "Great Place to Work" since 2015.

Position Summary

The Premium Billing Reconciliation Specialist role supports the accuracy and integrity of enrollment data by overseeing the day to day operational activities of member profile management and health plan data reconciliation. This position ensures compliance with all policies, procedures, and regulations related to Medicare, DOD and the Bureau of Insurance enrollment data reconciliation.

Job Description

Key Outcomes :

• Maintains expertise in premium billing knowledge. Serves as a learning resource within team and other area departments related to basic and complex premium payment processing.
• Works collaboratively within Finance team to ensure timely response to member premium related requests, inquiries and issues.
• Consistently meets or exceeds department accuracy and productivity goals.
• Identifies process and workflow gaps, manages process improvement activities to resolve opportunities.
• Assists Supervisor in developing and distributing standard work and ad hoc reports
• Ability to maintain skillset and support for all listed Premium Billing Specialist tasks to cover and provide support as needed
• Performs quality assurance reviews on the reporting and data to identify trending issues and opportunities for resolution
• Performs entry level oversight of reporting reconciliation and data validation to include daily, weekly and monthly billing
• Supports compliance and audit activities, including compilation of documentation requested by internal and external auditors as well as development of corrective action plans. Will also assist in the implementation of any corrective action plans
• Manages account investigation and quality assurance of data found in the premium billing system.
• Processing member premium refunds and corrections as needed
• Resolve escalated premium related inquiries from members, external customers and key stakeholders
• Responsible for daily payment posting, upload or electronic payment processes and applications.
• Identifies system and process defects and provides recommendations for solutions.
• Partners with the Premium Billing Specialist II to manage the status and accuracy of overdue or underpaid accounts.
• Ability to generate and manage member invoices as request by members and other key stakeholders.
• Other related duties as assigned
• Ensure timely and compliant billing of members.

Education / Experience :

Requirements :

Skills / Knowledge / Competencies (Behaviors) :

There are additional competencies linked to individual contributor, provider and leadership roles. Please consult with your leader to discuss additional competencies that are relevant to your position.

This position is not eligible for immigration sponsorship.

We are an equal opportunity / affirmative action employer.

Do you have a question about careers at Martin's Point Health Care? Contact us at jobinquiries@martinspoint.org