Membership Accounting Advocate

Job Title: Membership Accounting Analyst

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.

Essential duties and Responsibilities:

Enrollment Processing

• Process queue items, inter-departmental and customer requests timely and accurately
• Review 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) Attestations
• Review and complete Other Health Insurance (OHI) verification and error correction
• Review 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 system
• Respond to billing-related correspondence
• Review and investigate returned checks, rejected ACH and credit card transactions
• Process requests for automated premium payment via credit card or ACH withdrawal
• Review and approve/deny customer requests for premium refunds in accordance with established policies
• Monthly State Pharmaceutical Assistance Programs reconciliation

Reconciliation Processing

• Researching and correcting errors, discrepancies, and rejected transactions received from:
• CMS on the Daily Transaction Reply Report (DTRR)
• CMS Daily and Monthly Reconciliation queues
• Daily and Monthly Pharmacy Benefit Manager (PBM)
• Monthly MMR, PWR, LIS History and LEP Reconciliation
• Daily OHI/COB Rejections
• Monthly review and preparation of the CMS Enrollment Data Validation file and submissions

All Functions

• Working understanding of Centers for Medicare & Medicaid Services (CMS) guidance
• Conform with and abide by all regulations, policies, work procedures and instructions
• Meet CMS guidelines and client Service Level Agreement (SLA) requirements through the proper handling of transactions
• Perform outbound calls to customers or other entities as permitted to complete processing of enrollment, disenrollment, billing and or reconciliation transactions
• Make appropriate system corrections and escalate transactions that are unable to be corrected
• Prepare reports as requested by management
• Perform other duties and responsibilities as required

Education and Experience:

• High school diploma required; Associates Degree or higher preferred
• Minimum 2 years Health Plan Operations experience including; Enrollment (preferred), Claims processing or Customer Service.
• Working knowledge of MSOffice (Word, Excel, Outlook)