Enrollment Analyst - B2B Staffing Services
Long Beach, CA
About the Job
| Summary: Provide data and analytical support to the health plan for enrollment, capitation premium and birth payment reconciliations. Essential Functions: Manage the daily process of member exceptions from state eligibility file and take appropriate action to ensure members are properly enrolled. Reconcile capitation premium received monthly from the State with those members that were eligible for that period. Research discrepancies from state payments in order to ensure accurate payment to the health plan. Reconcile birth payments received from the State with those that were expected based on encounters submitted. Manage and prepare daily performance reports summarizing key performance indicators regarding enrollment statistics. Track and follow up on any exceptions with revenue amounts expected from the State and maximize recovery. Compile and review all reports, historical trends and forecasts future enrollment activities. Serve as resource for responding to and resolving requests from MHMO members, internal and external customers regarding member changes including eligibility/terminations and PCP changes. Prepare, review, update and monitor Standard Operating Procedures for enrollment, to ensure proper process documentation, as well as compliance with state regulations. Interface with other business units within the company with respect to design, enhancement and maintenance of enrollment reporting and/or databases. Knowledge/Skills/Abilities: Excellent verbal and written communication skills Ability to abide by policies Maintain regular attendance based on agreed-upon schedule Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA) Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers Required Education: Bachelor?s degree in Accounting and/or Business or equivalent experience Required Experience: 0-2 years of relevant work experience Proficient in Microsoft Excel and Word. Excellent organizational and interpersonal skills. |
Source : B2B Staffing Services
