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Data Entry
Location: Remote, Remote, US
Requisition ID: 3957
Description
Purpose:
- Assist client with Billing and Enrollment issues for their Marketplace program.
Position Definition:
- Work through adverse scenarios impacting a member’s enrollment status in their Marketplace policy.
- Apply premiums paid by members on their Marketplace policy.
Position Characteristics:
- Compile records, and evaluate personal and financial data. Keep records of assigned cases and prepare reports.
Essential Duties and Responsibilities (include but are not limited to):
- Processes daily enrollee invoices and premium reconciliation for members
- Reconciles unallocated payments, monies, and premiums received from the inidual subscriber or responsible party with the amount due for the healthcare program the member is enrolled in.
- Resolves invoice discrepancies prior to monthly report run.
- Performs month-end invoicing and accuracy audits. Resolve eligibility issues affecting premium billing. Generates reports and billing data using the premium billing module to be sent to print and fulfillment vendor.
- Reconciles eligibility data to ensure that the member data loaded in system matches the file (exception report).
- Works PCP exception report – assigns member to PCP.
- Works pharmacy exception report – validates eligibility updating system and website.
- Works vision exception report – validates eligibility and updates system.
- Works ID card exception report – validates member demographic information updating system accordingly and regenerates ID card as needed.
- Complete member moves – reassigning member from one PCP to another.
- Works monthly eligibility reconciliation (audit file/baseline vs. system) – updates eligibility data in system accordingly.
- Confirms monthly reporting. Validates eligibility by updating system accordingly using premium file details.
Knowledge, Skills and Abilities:
- Any combination of education, experience, and training that would likely provide the required knowledge and abilities in qualifying.