Job Description
Job Description
Purpose
Contributes to the overall success of the Billing & Collections Department ensuring specific individual goals, plans, initiatives are executed / delivered in support of the team's business strategies and objectives. The Revenue Operations Specialist will be responsible for the billing, employer group set up and rate entry, cash application, and collections processes for our health insurance company. This position has a positive impact on our cash flow. The ideal candidate will be detail-oriented, organized, and have excellent communication skills. Ensures all activities conducted are in compliance with governing regulations, internal policies and procedures.
Accountabilities
Facilitate the billing process, including the creation and distribution of invoices and the resolution of billing-related issues.
Coordinates monthly invoicing process, ensuring revenue is complete, accurate, and in compliance with customer contracts
Resolves premium billing and premium payment discrepancies directly with members, employer groups and other customers
Perform Small & Large Employer Group set up including all associated divisions with benefit and rate information. This includes new groups through intermediaries.
Medicare Advantage, Medicare Supplement and Medicaid set up and rate entry
Updates rate and benefit information in AMISYS for any client level changes including but not limited to benefit plan changes, renewal rate changes, terminations, and reinstatements following the appropriate procedure and timing guidelines.
Processes all of HNE's cash receipts including lockbox deposits, wire transfers, EFT, checks, and ACH payments for Commercial, Medicare Supplement, and Medicare groups/members by uploading payments, payment files or manually entering into billing systems, such as Amisys and Market Prominence.
Reviews daily cash deposited in all HNE accounts. Reconciles and signs off on daily premium cash received to the posted cash documentation for all lines of business to ensure that all premium deposits are accounted for.
Assists with managing the relationship with HNE's online premium payment vendor and external collection agency.
Coordinate the collections process, including the timely resolution of delinquent accounts and the initiation of collections actions when necessary.
Reviews and approves collection agency payment options to achieve the highest return possible, while maintaining a professional customer relationship
Reviews all pharmacy claims paid out of coverage. Coordinates with the Pharmacy Department to determine the best course of action regarding difficult outstanding member pharmacy costs. Contact members to attempt resolution and collection of pharmacy claims paid out of coverage.
Maintain accurate records of all financial transactions and ensure that all transactions are processed in accordance with company policies and procedures.
Prepare and analyze reports related to revenue operations, including aging reports, operational metrics and revenue forecasting reports.
Work closely with other departments, including but not limited member service, enrollment, underwriting, accounting, and finance, to resolve issues and improve processes.
Stay up-to-date with industry trends, regulations and best practices related to revenue operations.
Position Revenue Operations Specialist/ Billing and Reconciliation
Reporting Relationships (Job Titles only)Primary Manager:
(include secondary Manager if applicable)
Billing & Collections Manager
Direct Reports:
N/A
External/Internal Contacts
Internal
Revenue Management
External
Health New England
Education / Experience / Other Information (include only those that are specific to the role)
Bachelor's degree in finance, accounting, business administration, or a related field and minimum of 2 years of experience in billing and/or collections in the healthcare industry or an equivalent combination of education and experience.
Proficiency in Microsoft Excel and other accounting software.
Strong attention to detail and ability to work independently.
Excellent communication and interpersonal skills.
Ability to prioritize tasks and meet deadlines in a fast-paced environment
Ability to problem solve and critical thinking
Knowledge HNE's core administrative system (Amisys, Market Prominence, etc.) preferred
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