JOB SUMMARY:

Daily oversight and supervision of the Eligibility and Premium Billing team. Responsible for various tasks related to both enrollment and/or premium billing functions. Written and verbal interaction with internal and external customers related to research, audits, complaints, issues and grievance resolution. Responsible for reading, understanding and actively interpreting regulations from CMS, HHS, and other state and federal regulating agencies and its impact to billing and enrollment functions. Responsible for relationship development and collaboration with key stakeholders and third party vendor

MINIMUM QUALIFICATIONS:

Education/Specialized Training/Licensure:

• High School Degree or GED

Work Experience (Years and Area):

• Five (5) years related experience in managed care, Member account management, eligibility file/premium billing experience.
• Bachelor's degree maybe substituted for work experience.

Management Experience (Years and Area):

• Six (6) months leadership/supervisory experience.

Equipment Operated:

• Computer literate. MS Office (Excel, Word, Outlook)

SPECIAL REQUIREMENTS: (Check Applicable Areas)

Communication Skills:

• Above Average Verbal (Heavy Public Contact)
• Exceptional Verbal (e.g., Public Speaking)
• Writing /Composing Yes (Correspondence / Reports)

Other Skills:

• Analytical
• Mathematics
• Medical Terminology
• Research
• Statistical
• PC
• MS Word
• MS Excel

Other Requirements:

• Possess a high level of critical thinking and problem solving.
• Have the ability to read and interpret different types of data efficiently.
• Have an ability to interpret CMS and HHS guidelines and legislation.
• Must possess intermediate skills using Microsoft office products such as Excel, Word and PowerPoint. Must have basic math skills and the ability to understand accounts receivables and billing cycles.
• Accounting knowledge is a plus.

RESPONSIBLE TO:
Supervisor/Manager

EMPLOYEE SUPERVISED: