Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force of "people caring for people," Martin's Point employees are on a mission to transform our health care system while creating a healthier community. Martin's Point employees enjoy an organizational culture of trust and respect, where our values - taking care of ourselves and others, continuous learning, helping each other, and having fun - are brought to life every day. Join us and find out for yourself why Martin's Point has been certified as a "Great Place to Work" since 2015.
Position Summary:
The Premium Billing Reconciliation Specialist role supports the accuracy and integrity of enrollment data by overseeing the day to day operational activities of member profile management and health plan data reconciliation. This position ensures compliance with all policies, procedures, and regulations related to Medicare, DOD and the Bureau of Insurance enrollment data reconciliation.
Job Description
Key Outcomes:
- Maintains expertise in premium billing knowledge. Serves as a learning resource within team and other area departments related to basic and complex premium payment processing.
- Works collaboratively within Finance team to ensure timely response to member premium related requests, inquiries and issues.
- Consistently meets or exceeds department accuracy and productivity goals.
- Identifies process and workflow gaps, manages process improvement activities to resolve opportunities.
- Assists Supervisor in developing and distributing standard work and ad hoc reports
- Ability to maintain skillset and support for all listed Premium Billing Specialist tasks to cover and provide support as needed
- Performs quality assurance reviews on the reporting and data to identify trending issues and opportunities for resolution
- Performs entry level oversight of reporting reconciliation and data validation to include daily, weekly and monthly \ billing
- Supports compliance and audit activities, including compilation of documentation requested by internal and external auditors as well as development of corrective action plans. Will also assist in the implementation of any corrective action plans
- Manages account investigation and quality assurance of data found in the premium billing system.
- Processing member premium refunds and corrections as needed
- Resolve escalated premium related inquiries from members, external customers and key stakeholders
- Responsible for daily payment posting, upload or electronic payment processes and applications.
- Identifies system and process defects and provides recommendations for solutions.
- Partners with the Premium Billing Specialist II to manage the status and accuracy of overdue or underpaid accounts.
- Ability to generate and manage member invoices as request by members and other key stakeholders.
- Other related duties as assigned
- Ensure timely and compliant billing of members.
Education/Experience:
- High School Diploma required. Post-Secondary Education preferred
- 2+ years of health plan membership enrollment and/or billing processing experience
- Experience with plan enrollment and supporting systems
Requirements:
- Terms of employment may require the applicant/incumbent to qualify, obtain and maintain a Position Level of Trustworthiness from the U.S. Government Office of Personnel Management.
- In compliance with MPHC’s Department of Defense government contract, any/all persons hired for this position will need to verify their US citizenship and complete the required employment eligibility verification upon hire.
Skills/Knowledge/Competencies (Behaviors)
- Demonstrates an understanding of and alignment with Martin’s Point Values.
- Experience working with Managed Care eligibility processes and systems, preferably with Government health care programs
- Exceptional analytical skills
- Intermediate knowledge of Microsoft Access and Excel is required
- Must be detail and deadline oriented, flexible, and able to function effectively in a fast-paced environment
- Must have excellent communication skills as this position interacts with individuals outside the organization.
- Detail oriented with excellent follow up skills
- Must be able to work a flexible schedule, including weekends and holidays when necessary
There are additional competencies linked to individual contributor, provider and leadership roles. Please consult with your leader to discuss additional competencies that are relevant to your position.
This position is not eligible for immigration sponsorship.
We are an equal opportunity/affirmative action employer.
Do you have a question about careers at Martin’s Point Health Care? Contact us at: [email protected]
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What We Do
Martin’s Point Health Care is an innovative not-for-profit health care organization offering high-quality, affordable health care and coverage to the people of Maine and throughout New England.
Martin’s Point has seven health care centers in Maine and New Hampshire offering primary and specialty care to those with most major health insurance plans. Martin’s Point also administers two health insurance plans: Generations Advantage—with the only 5-Star Medicare Advantage plans in northern New England, and the US Family Health Plan for active duty military families and retirees throughout most of northern New England and New York.
We believe that understanding both the clinical and health plan administrative side gives us the insight we need to make meaningful improvements to the health care system. Martin’s Point is dedicated to creating a community of healthy people through authentic relationships and trust
