Senior Specialist, Premium Reconciliation & Billing (Must Reside in WI)

Molina Healthcare

2d•$15 - $29

About The Position

Under limited supervision, drives and supports reconciliation of premiums for members enrolled though the Healthcare Marketplace as a part of the Affordable Care Act (ACA). Reconciliation will be performed for more complex premiums received from members, state agencies and CMS. Team member will work closely with enrollment teams and offer guidance where premiums are directly impacted by enrollment discrepancies. Collaborate with and advises call center teams to maintain member satisfaction for this product. Work with financial institutions to ensure timely and accurate processing of payment received.

Requirements

Marketplace, Commercial, or Medicare healthcare experience with premium billing and reconciliation.
Must have excellent time management and organizational skills.
Strong team-oriented individual.
Excellent communication with all levels of team.
Must have strong knowledge and experience in MS office products, minimally Outlook, Word and Excel.
Access or SQL experience is a plus.
Excellent verbal and written communication skills.
Ability to abide by Molina's policies.
Maintain regular attendance based on agreed-upon schedule.
Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).
Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers.
High School diploma required
3+ years of Member Billing /R
Marketplace, Commercial or Medicare Industry preferred

Nice To Haves

Associates Degree or higher preferred
Healthcare industry experience, with emphasis on enrollment, member billing, and premium reconciliation preferred.
None

Responsibilities

Process daily enrollee's (Individual and family) invoices and premium reconciliation for Marketplace members.
Reconcile premiums received from the individual subscriber or responsible party with the amount due for the healthcare program the member is enrolled.
Guide and support Member Service representatives to help them resolve member inquiries related to healthcare premium.
Assist in resolution for escalated premium issues with Appeals and Grievances team members.
Guide and collaborates with enrollment team to resolve eligibility issues affecting premium billing.
Generate billing data using the QNXT premium billing module to be sent to print and fulfillment vendor.
Reconcile unallocated payments on a daily basis.
Resolve orphan member payments on a daily basis.
Reconcile monies received from the financial institution.
Perform month-end invoicing and accuracy audits.
Comply with all State/Regulatory requirements.