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Premium Billing Analyst

Company: SCAN Health Plan
Location: Long Beach
Posted on: November 21, 2022

Job Description:

SCAN Group is a not-for-profit organization dedicated to tackling the most pressing issues facing older adults in the United States. SCAN Group is the sole corporate member of SCAN Health Plan, one of the nation's leading not-for-profit Medicare Advantage plans, serving more than 270,000 members in California, Arizona, and Nevada. SCAN has been a mission-driven organization dedicated to keeping seniors healthy and independent for more than 40 years and is known throughout the healthcare industry and nationally as a leading expert in senior healthcare. SCAN employees are a group of talented, passionate professionals who are committed to supporting older adults on their aging journey, while also innovating healthcare for seniors everywhere. Employees are provided in-depth training and access to state-of-the-art tools necessary to do their jobs, as well as development and growth opportunities. SCAN takes great pride in recognizing our team members as experts in their fields and rewarding them for their efforts. If you are interested in becoming part of an organization that is innovating senior healthcare visit -www.thescangroup.org , -www.scanhealthplan.com , or follow us on LinkedIn, Facebook, and Twitter.The jobThe Premium Billing Analyst oversees and coordinates the transmission and receipt of membership billing data to & from CMS and the plan's payment processing vendor, maintaining compliance and adherence with regulatory requirements. The Premium Billing Analyst ensures compliance with CMS regulations, participates in audits to verify that the department standards for processing turnaround times, submission deadlines and quality standards are being met. The Premium Billing Analyst resolves discrepancies and prepares Premium Billing related reports to Management. The Premium Billing Analyst oversees and maintains business processes that govern Premium Billing functions as they relate to member billing, recording payments, reconciling Premium Billing reports, reconciling membership payment elections, developing and notifying delinquent members, and issuing member refunds. The Premium Billing Analyst provides customer service resolution and responses to internal business units at SCAN as well as externally to members.You Will

  • Retrieve and analyze vendor reports for comparison with the plan's stored membership information to identify, address, and resolve premium payment option discrepancies between the plan and CMS and/or the plan's processing vendor.
  • Design and develop internal processes using Microsoft office applications and SQL queries to facilitate data analysis, develop internal work lists and reports used to drive process improvements, address system deficiencies, and identify training needs.
  • Run monthly delinquency development process to identify all past due member accounts and issue notifications accordingly CMS guidance and regulation.
  • Generate and resolve reconciliation reports related to terminated members and outstanding Premium Billing statuses for billing and/or payments.
  • Manually review membership records to validate delinquency statuses developed through automated processes to confirm accurate development for disenrollment.
  • Retrieve and analyze vendor reports for reconciliation of auto-payment statuses, and declining payments.
  • Process member refunds electronically through the vendor's payment system, and/or manually via Access databases.
  • Complete membership mailings via Access databases and mail merges through Microsoft Word.
  • Confirm daily system functionality is successful through monitoring of dashboard reports in IKA Systems.
  • Schedule, run, and validate monthly invoice records to ensure accurate and complete billing for appropriate membership groups for both individual billing and Employer Group billing.
  • Reconcile and complete Exception Reports as related to payment files received from members, CMS, and Employer Groups.
  • Complete inbound and outbound calls to members to explain specific Premium Billing actions on member accounts and resolve member concerns or complaints.
  • Retrieve and address member escalated issues, or concerns, via internal routing system.
  • Participate and lead activities to resolve identified system deficiencies related to Premium Billing through deficiency assessment, impact analysis, reporting, testing, and implementation.
  • Participate and lead process design sessions by reviewing data reports from CMS, and contractors to: Identify and respond to information requests from CMS and Medicaid contractors, internal business units, and member inquiries.
  • Perform routine data analysis on Premium Billing membership data to identify, report, and mitigate potential risks to critical business processes as necessary.
  • Monitor and audit financial data reports produced by the plan's system vendor for Premium Billing.
  • Contribute to team effort by accomplishing related results as needed.
  • Actively support the achievement of SCAN's Vision and Goals
  • Bachelor's Degree or equivalent education/work experience, preferred.
  • 3+ years of relevant Accounting experience, preferred.
  • 3+ years of relevant Business Analysis experience, preferred.
  • Prior experience in Premium Billing, Accounts Receivable, Banking or similar setting.
  • Must possess excellent communication skills in one on one and group settings.
  • Must possess ability to work independently.
  • Strong analytical and problem solving skills.
  • Team player and self-starter high level of attention to detail.
  • Proficient in MS Office, including Microsoft Excel and Access.
  • Prior experience in SQL, preferred.What's in it for you?
    • A competitive compensation and benefits program -
    • An annual employee bonus program
    • Robust Wellness Program
    • Generous paid-time-off (PTO)
    • Eleven paid holidays per year, plus 1 additional floating holiday
    • Excellent 401(k) Retirement Saving Plan with employer match
    • Robust employee recognition program
    • A work-life balance
    • An opportunity to become part of a team that makes a difference to our members and our community every day!To ensure a healthy and safe work environment, if you are selected for this position, your job offer with SCAN Health will be contingent upon being fully vaccinated and providing proof of your COVID-19 vaccine within 3 days after your start date. Generally, you are considered fully vaccinated 14 days after receiving the last dose, as recommended by the manufacturer, of a vaccine that has been authorized by the FDA for use in the United States, including vaccinations that have been approved pursuant to an Emergency Use Authorization. If fully vaccinated outside of the United States, the vaccination must be listed for emergency use by the World Health Organization (WHO). If you cannot receive the vaccine because of a disability/medical reason or sincerely-held religious belief, you may request an accommodation to this requirement by contacting -COVID-19 Vaccination Policy . Learn more about the COVID-19 vaccination here - -https://www.cdc.gov/coronavirus/2019-ncov/vaccines/index.html We're always looking for talented people to join our team! Qualified applicants are encouraged to apply now!At SCAN we believe that it is our business to improve the state of our world. Each of us has a responsibility to drive Equality in our communities and workplaces. We are committed to creating a workforce that reflects our community through inclusive programs and initiatives such as equal pay, employee resource groups, inclusive benefits, and more. -SCAN is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required. #LI-JR1Equal Opportunity Employer/Protected Veterans/Individuals with DisabilitiesThe contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)

Keywords: SCAN Health Plan, Long Beach , Premium Billing Analyst, Accounting, Auditing , Long Beach, California

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