Enrollment and Billing Representative

Looking for a way to make an impact and help people?

Join PacificSource and help our members access quality, affordable care!

PacificSource is an equal opportunity employer.  All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths.

This position follows established policies and procedures to process a multitude of transactions for Government line of business including but not limited to: demographic updates, notification letters, enrollments, disenrollments, reinstatements, and plan changes.

Essential Responsibilities:

• Process daily returned mail, making any related changes in EAM & Facets contacting the member if needed, and resending documents or processing as required by CMS.
• Manually create and send Out of Area letters to members who may have moved out of the service area. Research, make changes, and/or complete any Call Tracks regarding enrollment/membership in Facets.
• Respond to any inquires received via phone calls, e-mails, etc, researching or providing info needed or making any necessary changes to member files as needed for the Government line of business.
• Add or correct member data in our pharmacy vendor database.
• Process all Medicare membership enrollment, plan changes, facilitated enrollments and reinstatements.
• Review the daily EAM Validation report and make corrections as necessary.
• Process all Medicare membership cancellation of enrollments, cancellation of disenrollment’s and death notifications.
• Process the CMS Enrollment Data Verification monthly audit for address and enrollment updates.
• Answer Queue Customer Service calls for Medicaid/Medicare members regarding eligibility.
• Submit miscellaneous transactions to CMS daily as needed.
• Respond to insurance verification requests for Medicare members.
• Perform scanning and key wording of ROI’s/POA’s in to Onbase for the Government line of business.
• Load ROI/POA documentation in to Facets.
• Work the monthly P2P report for Accounts Payable Download CMS applications, upload electronic applications in to EAM, save applications and perform indexing of applications in onbase.
• Process all Medicare COB. Send COB letters to members, update Facets and the COB database and submit member information backs to ECRS.

Supporting Responsibilities:

• Follow company and department policies.
• Meet department and company performance and attendance expectations.
• Provide backup support for other members of the enrollment team.
• Ability to judge severity of problems and the need to escalate to peers and/or management.
• Support and participate in continuous improvement initiatives.
• Maintain professional, service oriented relationships.
• Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
• Perform other duties as assigned.

Work Experience: Minimum 2 years of administrative experience with at least 1 year in health insurance billing or related healthcare experience required. Demonstrated ability to work efficiently and effectively with a high attention to detail.

Education, Certificates, Licenses: High School Diploma or equivalent required.

Knowledge: Ability to understand and interpret Federal and Oregon State laws and contract provisions. Proficiency in Microsoft Applications. Demonstrated organizational and time management skills. Requires keyboarding and 10-key skills. Experience with problem solving and ability to read system reports.

Competencies:

Building Customer Loyalty

Building Strategic Work Relationships

Contributing to Team Success

Planning and Organizing

Continuous Improvement

Adaptability

Building Trust

Work Standards

Environment: Work inside in a general office setting with ergonomically configured equipment. Travel expected less than 5% of the time.

Skills:

Accountability, Collaboration, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork

Our Values

We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:

• We are committed to doing the right thing.
• We are one team working toward a common goal.
• We are each responsible for customer service.
• We practice open communication at all levels of the company to foster individual, team and company growth.
• We actively participate in efforts to improve our many communities-internally and externally.
• We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
• We encourage creativity, innovation, and the pursuit of excellence.

Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.