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Enrollment & Billing Representative I

Company Name:
PacificSource Health Plans
This position follows established policies and procedures to process a multitude of Medicare transactions and Medicare member transactions including, but not limited to:
Enrollments
Disenrollments
Reinstatements
Plan Changes
Notification Letters
1. Process all Medicare membership enrollments for the AEP and SEPs daily.
2. Process all Medicare membership plan changes during AEP and daily SEPs.
3. Process all Medicare membership disenrollments: Voluntary, involuntary, cancellation of disenrollments, death and all SEPs disenrollments.
4. Manually create and send Out of Area letters to members who may moved out of the service area.
5. Process monthly Terms for non-payments and process auto/facilitated enrollments bi-weekly.
6. Generate and send notification letters and other letters as required by CMS for enrollments as well as other various reasons as needed daily.
7. Submit SSA deduction transactions, as well as any other necessary transactions to CMS as needed daily.
8. Provide backup for disenrollments and Out of Area processes.
9. Process daily returned mail, making any related changes in EAM & Facets contacting the member if needed, and resending documents or processing as required by CMS.
10. Respond to any inquires received via phone calls, e-mails, etc, researching or providing info needed or making any necessary changes to member files as needed.
11. Research, make changes, and/or complete any Call Tracks regarding enrollment/membership in Facets.
12. Process all Medicare COB. Send COB letters to members, update Facets and the COB database and submit member information backs to ECRS.
13. Submit retro enrollments/reinstatements/disenrollments when necessary to Reed & Associates or Regional Office.
Supporting Responsibilities:
1. Follow company and department policies.
2. Meet department and company performance and attendance expectations.
3. Provide backup support for other members of the enrollment team.
4. Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
5. Perform other duties as assigned.
Work Experience: 2 years of
administrative
experience, health insurance billing experience preferred.
Education, Certificates, Licenses: High School Graduate. Associate's Degree in business or accounting, or equivalent work experience.
Knowledge: Ability to understand and interpret Federal and
oregon
State laws and contract provisions. Requires strong keyboard skills and 10-key skills. High level of problem-solving skills.
Competencies
Our Values
Building Customer Loyalty
Building Strategic Work Relationships
Continuous Improvement
Adaptability
Building Trust
Work Standards
Contributing to Team Success
Planning and Organizing
We are committed to doing the right thing.
We are one team working toward a common goal.
We are each responsible for our customer's
experience.
We practice open communication at all levels of the company to foster individual, team and company growth.
We actively participate in efforts to improve our many communities-internally and externally.
We encourage creativity, innovation, continuous
improvement and the pursuit of excellence.
Environment: Work inside in a general office setting with ergonomically configured equipment.
Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.
Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.
PacificSource is an equal opportunity and affirmative action employer.
Date: 2014-03-13
Country: US
State: OR
City: Bend
Postal Code: 97701
Job Type: Regular Full-Time

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