Premium Billing Associate

COMMUNITY HEALTH PLAN OF WASHINGTON

JOB DESCRIPTION

 

Premium Billing Associate

 

Key Relationships:

Reports To:  Accounts Receivable Supervisor

 Supervises: None

 Other Key Relationships:  AVP Finance, Controller, Eligibility Supervisor

 

FLSA: Non-Exempt

 

Position Purpose:

The Premium Billing Associate is responsible for daily, weekly, and monthly activity maintenance for the premium accounts receivable cash-related processes, specifically the Medicare, PEBB, and Individual Commercial product lines.  Responsibilities include monthly deposit account reconciliation, as well as providing assistance for monthly reconciliation of member premium accounts.   Responsibilities also include providing feedback regarding procedural needs, in accordance with Medicare/Medicaid guidance.  

 

Principle Duties:

A. Generation of deposit for premium payments sent via check, as needed, and reconciliation of payments to the accounts receivable.

B. Research past due premium letters, to identify possible information discrepancies.

C. Monthly reconciliation to the accounts receivable, for automated monthly premium payments received.

D. Customer service-related call issues, pertaining to premium billing.

E.   Assist with monthly reconciliation and analysis to maintain accuracy of premiums receivable and related general ledger accounts, including both balance sheet and income statement accounts.

F.   Reconciliation of Medicare Advantage and Part D premium payments and subsidies received from CMS.

G. Process and reconcile premium payments via EFT, direct payments, or SSA Deduction.

H. Assist in preparation of information for encounter data submission.

I.   Provide support for review & reconciliation of Medicare premium risk adjustments

J. Other duties as assigned.

 

Qualifications:

Education:

Two year degree required, concentration in an accounting-related field preferred.

 

Prior Related Experience

One to three years of managed health care (or health insurance) experience particularly in the areas of premium billing, accounts receivable, & enrollment processing.  Experience with Medicare and Medicaid programs strongly preferred.  Knowledge of cash application and bank reconciliation methods required.

 

Knowledge, Skills, and Abilities:

?  Strong analytical skills

?  Knowledge of insurance premium billing process

?  Knowledge of financial accounting practices and internal control processes.

?  Knowledge of accounting and financial reporting software required (ACCPAC, Oracle, Crystal Reports, a plus)

?  Knowledge of  Medicare & Medicaid insurance administration software (QCSI, Infocrossing, HPMS, MARX, MMIS, a plus)

?  Demonstrates high degree of proficiency with Excel and Access.

?  Strong analytical and problem solving skills

?  High level of attention to detail

?  Team player, self-starter able to work with little supervision

?  Sensitivity to the needs of every individual to be treated with respect and fairness.

?  Ability to maintain a professional demeanor and confidentiality.

?  Written and oral communication skills.

?  Organizational and multi-tasking skills.

 Physical Requirements

The position primarily requires minimal physical effort. The working conditions typically involve normal office work, typing, sitting at a desk.  No traveling is required for this position.

 

Other:

Eligible to participate in local, state and federal health care programs including Medicare and Medicaid. Access to Private Health Information

Individuals performing the principle duties of the Accountant-Healthcare must have access to, and protect the confidentiality of the following minimum necessary information in order to perform the job functions:

 

? member demographic information as a result of accessibility to the health care administrative software

? premium and eligibility reports which detail member/subscriber information

? database information which includes claim information including paid amounts, coverage amounts and other health care information on each member

 

The above is intended to describe the general content of and the requirements for satisfactory performance in this position.  It is not to be construed as an exhaustive statement of the duties, responsibilities, or requirements of this position.