Department:OH1CH_70512_000 Enrollment & Premium Billing
Expected Weekly Hours:40
Position Purpose:At Mount Carmel, we work to continuously inspire one another. Here, all are welcome. It is this culture of humility and compassion that sets Mount Carmel apart. We see the big picture and do the right thing. That means a dedication to the well-being our both our colleagues and the patients they serve.
MediGold is a not-for-profit Medicare Advantage insurance plan serving seniors and other Medicare beneficiaries in Ohio. We’re dedicated to providing excellent customer service, cost-effective care, and exceptional healthcare coverage. We rely on talented colleagues in a wide variety of professional roles including information technology, financial analysis, audit, provider relations and more.
Job Description Details:
The MediGold Premium Billing Reconciliation Analyst performs all routine tasks related to monitoring and processing of member premiums as well as reconciliation and analysis of daily tasks and reports.
- Able to perform all the routine tasks of Premium Billing Department, including but not limited to payment posting, reconciliation, electronic funds transfer posting and maintenance, late letter process, processing of returned payments, billing statements ,evaluation and completion of reports
- Responsible for reconciliation of electronic postings, including lockbox and electronic funds transfer, manual posting, Returned payments, Member Refunds and other Premium Billing Reports
- Monitors and evaluates all Premium Billing reports on a routine basis, in addition to pre and post billing, nsf, Bad Debt Analysis, SSA Analysis, Prepaid Analysis
- Identifies and corrects Premium Billing discrepancies through report monitoring on a consistent basis, and in response to inquiries from other departments.
- Analyzes member accounts to ensure proper billing.
- Communicates regularly with Supervisor, Premium Billing on the Premium Billing status of the Plan membership, including but not limited to disclosure of errors, billing trends, issues, in order to assist in process evaluation and development.
- Assists in developing day to day processes for Premium Billing department.
- Responsible for day to day processing of Premium Billing related tasks in the plan's current Premium Billing system of record.
- Serves as a contact for operational problems and provides research as needed
- Engages in any outbound call duties including but not limited to; discussions with Plan members regarding past due amounts, calculation errors, posting errors and research inquiries.
- Prioritize work and meet established deadlines.
- Assists Supervisor, Premium billing in all tasks related to the Premium Billing Process, and any other department processes as needed.
- Assists Supervisor, Premium Billing in maintenance, development and testing of Accounts Receivable system, as needed.
- All other duties as assigned.
- Education: Associates degree in business or related field, or equivalent experience required.
- Experience: Minimum of 3 years' experience working in a health care organization and/or similar finance related field.
- Knowledge of insurance premium billing standards and collection tactics preferred
- Knowledge or familiar with Center of Medicare/Medicaid regulations preferred
- Must be able to work independently and exercise good judgment
- Strong ability to follow complex, detailed processes consistently with minimal data entry errors in conjunction with strict policies and procedures
- Ability to work in a heavily CMS regulated position and organization and able to deal with change at short notice
- Able to meet deadlines and expectations consistently
Discovering opportunities, support and excellence – all while making a real difference in patients’ lives – begins at Mount Carmel. Find a new beginning and advance your career with us.
Mount Carmel and all its affiliates are proud to be equal opportunity employers. We do not discriminate on the basis of race, gender, religion, sexual orientation or physical ability.
Trinity Health's Commitment to Diversity and Inclusion
Trinity Health employs more than 120,000 colleagues at dozens of hospitals and hundreds of health centers in 21 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.
Trinity Health's dedication to diversity includes a unified workforce (through training and education, recruitment, retention and development), commitment and accountability, communication, community partnerships, and supplier diversity.