About Fallon Health:
Founded in 1977, Fallon Health is a leading health care services organization that supports the diverse and changing needs of those we serve. In addition to offering innovative health insurance solutions and a variety of Medicaid and Medicare products, we excel in creating unique health care programs and services that provide coordinated, integrated care for seniors and individuals with complex health needs. Fallon has consistently ranked among the nation’s top health plans, and is accredited by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit www.fallonhealth.org.
Brief summary of purpose:
Under the direction of the Supervisor or Manager, the Enrollment & Billing Operations Representative I supports Fallon Health’s mission, vision and values by providing and maintaining timely and accurate enrollment and billing information. Documents pertinent information enabling tracking of group/subscriber/member and eligibility and adheres to internal and external SLA’s. With speed, accuracy, and integrity, ensures that enrollee data for Medicare Advantage, Medicare Supplement, NaviCare, Summit Elder Care, Fallon Health Weinberg and any future regulatory products is entered into Fallon Health’s core system. Completes work accurately and timely to remain in compliance with DOI, CMS and EOHHS regulations. Appropriately
escalates concerns when necessary and follows issues through to closure. Reviews problems not clearly defined by written directives or instructions with the Enrollment & Billing Operations Representative III, Enrollment & Billing Operations Supervisor, or Enrollment & Billing Operations Manager to determine course of action.
The Enrollment & Billing Operations Representative I collaborates effectively with co-workers and other departments to ensure quality service to our internal and external customers. Maintains a positive approach to issues and concerns as they arise, and works to identify and recommend process improvements to his/her direct supervisor/manager.
Pre-requisites for success in this position include: Strong verbal & written communication skills including demonstrated excellence in telephone communication skills; strong organizational skills, computer skills. Performs all functions necessary to maintain accurate subsidiary accounts receivable, and ensures accuracy of premium bills. Reconciles employer group bills to group payment listings or direct pay member bills, and appropriately researches. Reviews monthly Accounts Receivable Summary and Aged Trial Balance to identify problems with payments, etc.
Handles confidential customer information. Knowledgeable of plan policies, protocols, and procedures. Requires ability to work in a fast-paced environment with multi-disciplined staff. Consistently follows through on issue resolution. Strong multitasking abilities are essential along with taking accountability and understanding job functions can change based upon the business need. Initiates self-development via available company and industry educational opportunities
Enrollment & Billing Operations Representative is responsible for enrollment and billing maintenance, adhering to daily, weekly and monthly schedules and administrative related tasks.
Calculates 5500 Schedule A/C information for Medicare employer groups.
Participates in departmental and company-wide process improvement projects, training, testing and team meetings as assigned.
Performs other duties as they are assigned to meet department performance goals and to respond to changing priorities including administrative related tasks.
Works department returned mail
Quality control of enrollment and billing processes
Education: High School diploma required; Bachelor’s Degree preferred