Reconcilliation/Enrollment Specialist : Priority Health Job - (grand rapids, michigan) in Grand Rapids, Michigan For Sale
Reconcilliation/Enrollment Specialist : Priority Health
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Job ID : xxxx5
Bi:weekly Hours: 80
Entity: Corporate
Shift: Day
Employment Classification: Full:time with Benefits (A1)
Shift Length: 8 hours
Location: GRAND RAPIDS, MI
Hours of Work: 8 a.m. to 5 p.m.
Facility: Priority Health
Days Worked: Monday to Friday
Department: Ph:Medicaid
Weekend Frequency: N/A
Company Description
Spectrum Health is a not:for:profit, award winning, integrated health system based in West Michigan. Our organization includes a medical center, regional community hospitals, a dedicated childrens hospital, a multispecialty medical group and a nationally recognized health plan, Priority Health.We invest in our people by supporting a dynamic, high:performing workplace. Our collaborative approach to patient care includes a commitment to provide an exceptional experience for patients and their families. Spectrum Health supports successful career growth, in an innovative environment.
Position Summary
This position consists of Reconciliation and Enrollment functions on the Medicaid Operations Team. Essential responsibilities include, yet are not limited to: Acting as a lead for continuous monitoring and communications with internal departments to ensure timely reconciliation, resolution, and settlement with the State of Michigan premium payments; Reporting information to ensure timely enrollment of Medicaid and MIChild members; and Collaborating with internal departments (e.g., billing, information systems) to ensure operational compliance and cost:effective and process improvement initiatives are acted upon.
* Reconcile the State of Michigan premium payments for all Medicaid subgroups (e.g., MIChild) in a timely manner.
* Determine appropriate cash posting to monthly invoices for all Medicaid subgroups using the State of Michigan premium payment files as the source of truth.
* Effectively communicate the status of Medicaid reconciliations with appropriate internal departments and ensure inaccuracies are corrected in a timely manner.
* Oversee and ensure the enrollment of newborns via inquiries to the State of Michigan in a timely manner.
* Regularly monitor the State of Michigan enrollment files for all Medicaid subgroups and resolve discrepancies in a timely manner.
* Proactively identify, research, resolve and facilitate the settlement of payment discrepancies and communicate findings and recommendations to appropriate internal and external customers to ensure premium revenue and enrollment accuracies.
* Maintain a comprehensive understanding of ever:changing State of Michigan Medicaid eligibility rules, regulations, and guidelines and proactively recommend changes that minimize adverse impacts on enrollment and billing processes.
* Ensure assigned reconciliation and enrollment standard operating procedures (SOPs) are documented, easily retrievable, and updated in a timely manner.
Qualifications
Basic Qualifications:
Education : High School Diploma or GED
Preferred Qualifications:
Education : Associates Degree
Experience : Three years of experience in Managed Care experience. One year of experience in Enrollment, billing, and/or reconciliation experience. One year of experience in Working knowledge of core administrative system applications (eg, Facets) within a subscriber/member and customer service application group. One year of experience with Community Care Management Solutions (CCMS) systems (eg, Medifax, Netwerkes). One year of experience in Familiar with State of Michigan Medicaid and contract requirements and regulations. One year of experience in Experience with the State of Michigan inquiry system (eg, MI Enrolls). One year of experience in Knowledge of the State of Michigan Medicaid and MIChild programs.
We are an Equal Opportunity Employer and do not discriminate against applicants due to race, ethnicity, gender,
Source: http://www.tiptopjob.com/jobs/xxxxxxxx_job.asp?source=backpage