Senior Health Plan Billing Analyst

What We Provide

• Referral bonus opportunities
• Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays
• Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life Disability
• Employer-matched retirement saving funds
• Personal and financial wellness programs
• Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care
• Generous tuition reimbursement for qualifying degrees
• Opportunities for professional growth and career advancement
• Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities

What You Will Do

• Participates in the billing process with the Director of Billing for Medicaid members from enrollment to disenrollment. Reviews system file transfers between external/internal agents, VNS Health Plans, and NYS DOH Medicaid System (EMEDNY) to ensure acceptance and accuracy of data. Identifies problems and issues; works with supervisor and vendors on resolutions.
• Prepares reconciliation of the monthly premium and surplus billing for the review and approval of management. Reviews and analyze various membership reports in order to determine membership changes, census and premium billing accuracy. Performs ongoing audits of membership data maintained by the Membership Eligibility Unit (MEU) to confirm adherence to CMS guidelines.
• Manages and develops Medicare premium billing process for the Health Plan's Medicare products. Prepares reconciliation of membership information with MEU to confirm Medicare members are billed correctly based on their income level and status and ensure adherence to CMS guidelines and review any discrepancies with supervisor.
• Participates with management in the discussion with the auditors to provide background information on our workflows, membership data as it relates to premium and surplus billing, and various files that comply to CMS rules and regulations. Works with programs/agencies to gather data/information/documentation needed to comply with billing and auditing issues. Identifies and addresses issues/areas that can be improved to achieve better outcomes.
• Reviews and analyzes State membership reports (monthly membership reports, State rosters, etc.) to ensure membership eligibility data is updated and captured in the various membership systems as they relate to premium and surplus billing and share findings with manager to resolve any discrepancy.
• Prepares reconciliation of monthly payment reports from Medicaid and Instamed to confirm receipt of premium and surplus payments for active members and completion of retroactive adjustments. Reconciles Medicaid and surplus payments census with plan census and resolves discrepancies.
• Assists with the supervisor in developing procedures to maintain appropriate submission in claim processing and denials.
• Prepares and analyzes monthly billing financial, census and denials; submits corrections for payment. Reconciles reports for billing accuracy, receipt of payment, and/or accounts receivable.
• Works and assists with management to interprets/resolves billing issues related to new and existing Managed Care contracts. Makes recommendations on improving/amending provisions in contracts.
• Reviews information with management on monthly basis to ensure claims are billed and collected timely and manages escalated payor issues. Troubleshoots difficult or complex collection issues and as necessary, develops work/project teams to manage and resolve payment.
• Tracks and reports to the manager of any third-party vendor issues related to premium and surplus billing responsibilities and makes suggestions for improvements.
• Participates in special projects and performs other duties as assigned.

Education

• Bachelor's Degree in Finance, Business Administration, Health Administration or other related discipline required

Work Experience

• Minimum four years' experience required
• Proficient with personal computers, including Microsoft Office Products, with expertise in Excel required
• Strong analytical skills and a good understanding of the principles of finance and accounting required
• Effective oral, written and interpersonal communication skills required
• Finance experience in a Healthcare environment required