Enrollment and Billing Representative

PacificSource•Bend, OR

About The Position

Looking for a way to make an impact and help people? Join PacificSource and help our members access quality, affordable care! PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths. This position follows established policies and procedures to process a multitude of transactions for Government line of business including but not limited to: demographic updates, notification letters, enrollments, disenrollments, reinstatements, and plan changes.

Requirements

Minimum 2 years of administrative experience with at least 1 year in health insurance billing or related healthcare experience required.
Demonstrated ability to work efficiently and effectively with a high attention to detail.
High School Diploma or equivalent required.
Ability to understand and interpret Federal and Oregon State laws and contract provisions.
Proficiency in Microsoft Applications.
Demonstrated organizational and time management skills.
Requires keyboarding and 10-key skills.
Experience with problem solving and ability to read system reports.
Accountability
Collaboration
Communication (written/verbal)
Flexibility
Listening (active)
Organizational skills/Planning and Organization
Problem Solving
Teamwork

Responsibilities

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.
Manually create and send Out of Area letters to members who may have moved out of the service area.
Research, make changes, and/or complete any Call Tracks regarding enrollment/membership in Facets.
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 for the Government line of business.
Add or correct member data in our pharmacy vendor database.
Process all Medicare membership enrollment, plan changes, facilitated enrollments and reinstatements.
Review the daily EAM Validation report and make corrections as necessary.
Process all Medicare membership cancellation of enrollments, cancellation of disenrollment’s and death notifications.
Process the CMS Enrollment Data Verification monthly audit for address and enrollment updates.
Answer Queue Customer Service calls for Medicaid/Medicare members regarding eligibility.
Submit miscellaneous transactions to CMS daily as needed.
Respond to insurance verification requests for Medicare members.
Perform scanning and key wording of ROI’s/POA’s in to Onbase for the Government line of business.
Load ROI/POA documentation in to Facets.
Work the monthly P2P report for Accounts Payable
Download CMS applications, upload electronic applications in to EAM, save applications and perform indexing of applications in onbase.
Process all Medicare COB.
Send COB letters to members, update Facets and the COB database and submit member information backs to ECRS.
Follow company and department policies.
Meet department and company performance and attendance expectations.
Provide backup support for other members of the enrollment team.
Ability to judge severity of problems and the need to escalate to peers and/or management.
Support and participate in continuous improvement initiatives.
Maintain professional, service oriented relationships.
Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
Perform other duties as assigned.