Enrollment & Billing Specialist, MLTC and Medicaid

US-FL-Lake Mary
Requisition ID
2017-15125
Department Name
Enrollment and Billing

Overview

Healthfirst is a provider-sponsored health insurance company that serves more than 1.2 million members in downstate New York. With more than 4,000 employees, a network of nearly 30,000 providers, and revenues in excess of $8.6 billion, Healthfirst is one of the largest health plans in the New York City area.   Our members are our North Star, and our mission is guided by their needs and preferences in ensuring a superior experience and access to the highest quality healthcare when and where they need it. Healthfirst’s commitment to quality and member satisfaction has helped us earn top ratings for HMO health plans in New York City. We know that employees shape our company and connect us to our communities, and we look to recruit and retain intelligent, driven leaders who are passionate about healthcare and embody our five culture drivers: - Dream Big, Plan Wisely - Break Down the Walls - Think Critically, Speak Up, Deliver with Pride - Inspire Through Trust, Lead By Example - Be Unstoppable Position Summary: - The Enrollment & Billing Specialist (EBS) is responsible for enrolling new and renewing existing Healthfirst members into the Healthfirst Managed Healthcare System in an accurate and timely fashion. The EBS processes all member payment information, responds to member inquiries and performs account analysis.     Healthfirst is an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity or expression, veterans, disability status  or any other characteristic protected by law.

Responsibilities

Duties & Responsibilities: 

  • Maintain daily production and quality requirements to meet the department Service Level Agreement
  • Process and perform quality control measures on enrollment and disenrollment transactions and billing activities
  • Review and analyze eligibility and billing reports to ensure members are properly enrolled and premium payments correctly applied to accounts
  • Partner with Member Services and other departments to address and resolve member issues within the expected timeframes
  • Process payments and refunds, updating members’ accounts to reflect changes
  • Additional duties as assigned 

Qualifications

Minimum Qualifications: 

  • High School diploma or GED equivalent from an accredited institution
  • Work experience of multitasking between programs, data entry or client look up systems
  • Experience working with multiple Microsoft Excel worksheets including filtering and updating information on a daily basis
  • Experience using Microsoft Outlook including email, tasks and calendar functions
  • Experience using Microsoft Word for creating letters, memos and general correspondence
  • Experience with business process and customer relationship management systems
  • Ability to work overtime as the business requires 

Preferred Qualifications: 

  • Bachelor’s degree from accredited institution
  • Ability to solve problems and find solutions
  • Effective verbal and written communication skills
  • Previous auditing or analytical experience
  • Experience with data mining, report analysis or reconciliation experience within a healthcare billing or commercial insurance environment.
  • Experience with Microsoft Access as a database management system
  • Work experience reviewing, approving and processing applications or member records
  • Experience with reviewing New York State Medicaid/Medicare Health Plans 

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