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PacificSource Health Plans · 3 hours ago

Enrollment and Billing Representative

Bend, OR

Full-time

Onsite

Entry Level

$32K/yr - $52K/yr

2+ years exp

PacificSource Health Plans is committed to helping members access quality, affordable care. The Enrollment and Billing Representative processes transactions for the Government line of business, including enrollments, disenrollments, and demographic updates, while providing exceptional customer service to members.

CommunitiesCustomer ServiceNon Profit

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 inquiries 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

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