Enrollment & Billing Director oversees one or more departments responsible for enrollment and billing operations for an insurance company. Ensures information accuracy and customer satisfaction. Being an Enrollment & Billing Director establishes and implements organizational policies. May offer guidance on appropriate handling of complex or high-value accounts. Additionally, Enrollment & Billing Director typically requires a bachelor's degree. Typically reports to top management. The Enrollment & Billing Director manages a departmental sub-function within a broader departmental function. Creates functional strategies and specific objectives for the sub-function and develops budgets/policies/procedures to support the functional infrastructure. Deep knowledge of the managed sub-function and solid knowledge of the overall departmental function. To be an Enrollment & Billing Director typically requires 5+ years of managerial experience. (Copyright 2024 Salary.com)
About Fallon Health:Fallon Health is a mission-driven not-for-profit health care services organization based in Worcester, Massachusetts. For 45 years we have been improving health and inspiring hope in the communities we serve. Committed to caring for those who need us most, we pride ourselves on providing equitable access to coordinated, integrated care for our members with a special focus on those who qualify for Medicare and Medicaid. We also serve as a provider of care through our Program of All-Inclusive Care for the Elderly (PACE). Dedicated to delivering high quality health care, we are continually rated among the nation’s top health plans for member experience and service and clinical quality.
Brief Summary of Purpose:
Under the direction of the Supervisor or Manager, the Enrollment & Billing Operations Representative III 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. Problems not clearly defined by written directives or instructions are reviewed with the Enrollment & Billing Operations Supervisor or Enrollment & Billing Operations Manager to determine course of action.
The Enrollment & Billing Operations Representative III collaborates effectively with co-workers and other departments to ensure quality service to our internal and external customers. Interacts with departments such as Accounting, Sales and Regulatory Affairs. 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. Responsible for ensuring the integrity of information being entered & maintained within the QNXT system. Must have the ability to analyze various situations and be able to make independent decisions on best practices in the interest of the members and the health plan. The Enrollment & Billing Operations Representative III is considered the main resource person for all Regulatory staff for issues regarding the eligibility and reconciliation processes and will assist the Management team with projects and/or daily workload for all regulatory products. Responsible to reconcile the accuracy of payment file received from online premium payment vendor. Responsible for maintaining accuracy of Regulatory receivables based on dollars billed and received from customers, State and Federal agencies. Assist Account & Provider Configuration in working updates needed in sponsor configuration. This is handled through working DI reports.
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. Analyze/reconcile receivables balance for Commercial and Regulatory products to identify problems with payments and/or impose the delinquency process. Study the contractual terms and conditions to ensure payments received meet the contractual requirements.
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
The Enrollment & Billing Operations Representative III is responsible for enrollment and billing maintenance, adhering to daily, weekly, and monthly schedules and administrative related tasks.
Job Responsibilities:
Education:
High School diploma required; Bachelor’s Degree preferred
Experience:
Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
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