Job Description

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 billing 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 billing and payment data reconciliation.

Job Description

PRIMARY DUTIES AND RESPONSIBILITIES

• 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 the Accounting and 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
• Maintains 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.
• Processes member premium refunds and corrections as needed
• Resolves escalated premium related inquiries from members, external customers and key stakeholders
• Responsible for daily payment posting, upload or electronic payment processes and applications.
• Responsible for management and maintenance of special payment options
• 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.
• Generates and manages member invoices as request by members and other key stakeholders.
• Performs other related duties as assigned
• Ensures timely and compliant billing of members.

Employees are expected to work consistently to demonstrate the mission, vision, and core values of the organization.

POSITION QUALIFICATIONS

Education:

• High School Diploma required.
• Post-Secondary Education preferred.

Experience:

• 2+ years of health plan membership enrollment and/or billing processing experience.
• Experience with plan enrollment and supporting systems.
• Experience working with Managed Care eligibility processes and systems, preferably with Government health care programs.

Skills:

• Exceptional analytical skills.
• Proficient knowledge of Microsoft Excel is required.
• Must have excellent communication skills as this position interacts with individuals outside the organization.
• Detail oriented with excellent follow up skills

Abilities:

• Demonstrates an understanding of and alignment with Martin’s Point Values.
• Must be detail and deadline oriented, flexible, and able to function effectively in a fast-paced environment.
• Must be able to work a flexible schedule, including weekends and holidays when necessary

Pay Range: $22.62 - $27.94 The pay range above reflects the anticipated base pay range based on a full-time position. Actual compensation will be determined based on factors such as experience, skills, qualifications, and other job-related considerations. Employees may also be eligible for additional compensation, including incentive or commission-based programs, where applicable and subject to the terms of the relevant plan.

This position is not eligible for immigration sponsorship.

We are an equal opportunity/affirmative action employer.

Martin's Point complies with federal and state disability laws and makes reasonable accommodations for applicants and employees with disabilities. If a reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact jobinquiries@martinspoint.org

Do you have a question about careers at Martin’s Point Health Care? Contact us at: jobinquiries@martinspoint.org