The Business Analyst that will assist with Enrollment & Billing is responsible for overseeing the enrollment and disenrollment process for Medicare Advantage Plans. They will provide key support across the organization in areas including but not limited to eligibility, billing, general operations, and data management.
Job Responsibilities (but not limited to):
- Process enrollments and disenrollments, while providing key support across the organization to other departments involved in the eligibility.
- Documents pertinent information enabling tracking of group/subscriber/member and eligibility and adheres to internal and external SLA’s.
- Excellent follow up and customer service to the members of the plans that we service while following CMS Medicare regulatory and eligibility requirements.
- Provides knowledgeable response to internal and external inquiries and concerns regarding enrollment and billing including, but not limited to, qualifying events, policies and procedures, ID cards, letter correspondence (including Outbound Education and Verification), selection of primary care physician, premium invoices, payment inquiries and general eligibility and financial maintenance.
- Complete work accurately and timely to remain in compliance with DOI, CMS, and EOHHS regulations.
- Working knowledge of Medicare eligibility, as well as Medicare Advantage Prescription (MA-PD) enrollment processing
- Experience with CMS interfaces and systems for managing the Medicare enrollment and Billing functions
- The BA – Enrollment & Billing must have an ability to react very quickly and be nimble in providing responses and meeting the needs of the plans and our internal team members in a timely, calm, and professional manner.
- Develop a deep level of trust for Medicare members, understanding their needs, engaging the member on how the plan can best support them & their families, and orchestrating the initial enrollment with our team.
- With speed, accuracy, and integrity, ensures that enrollee data for Medicare Advantage, Medicare Supplement, and any future regulatory products is entered into nirvanaHealth’s system.
- Reconciles membership and billing reports as required by CMS, MassHealth and Employer groups (both automated and manual) to ensure accuracy of information.
- Appropriately escalates concerns when necessary and follows issues through to closure.
- Must have the ability to analyze various situations and be able to make independent decisions on best practices in the interest of the members and the health plan.
- Responsible to process payment files received from online payment vendor.
- Analyze/reconcile receivables balance for Regulatory products to identify problems with payments and/or impose the delinquency process.
- Processes all transactions related to customer data in a timely and accurate manner. Escalates inventory backlog daily
- Conduct extensive data analysis and develop various reports using SQL.
- Knowledgeable of plan policies, protocols, and procedures.
Education and/or Training:
- High School Diploma or equivalent degree required.
- Bachelor’s degree is preferred, or equivalent relevant experience in Medicare Enrollment Services.
- 3 – 5 years of Medicare enrollment experience preferred.
- Prior experience working in a health plan is preferred.
- Knowledge of Medicare eligibility, as well as the Medicare Advantage Prescription (MA-PD) enrollment processing.
- Excellent communicator with an uplifting, and personable manner with outstanding phone etiquette.
- Excellent written communication skills with success in providing notes, updates, and written communications via computer systems.
- Excellent data-entry skills and proven ability to navigate multiple computer screens.
- Must be able to multi-task and prioritize those tasks.
- Tenacious problem solver, with demonstrated capacity to embrace complex problems and arrive at effective solutions in a timely manner.
- Requires ability to work in a fast-paced environment with multi-disciplined staff.
- SQL, Tableau, Strong PC skills; MS Word, Excel, and Power Point.