What are the responsibilities and job description for the Premium Billing Specialist position at Apex Health Solutions?

Job Description

Summary

Position is responsible for conducting moderate to complex premium billing operations, membership and account record maintenance functions, and other duties in assigned areas to include generating premium billing invoices, performing premium billing and accounting audits, financial reconciliations, accounts receivable reporting reviews, and accurately tracking billing balances. This position requires a well-developed understanding of basic accounting principles and health insurance / health care industry billing practices.

Essential Functions include the following. Other duties may be assigned.

Participates in the planning, research, analysis, development and implementation of processes and workflows related to the premium billings of both commercial groups and Medicare Advantage members.
Develops and maintains an understanding of premium billing operations functions.
Collaborates with Finance and Account Management teams to identify and resolve discrepancies in member and account billings.
Reviews billed versus paid reports to determine account billing and delinquency statuses.
Performs account terminations resulting from requests, non-payment of premiums, and other reasons.
Collaborates with internal Finance team to perform account reinstatements resulting from overdue bill payments or account balance credits.
Maintains account information such as billing address, account representative, contact details, and other information to ensure timely communication with accounts.
Maintains documentation on all fact finding and resolution efforts resulting from premium billing inquiries / requests generated by internal and external stakeholders.
Performs monthly quality control functions by reviewing account billing statuses versus generated invoices.
Complies with all guidelines established by the Centers for Medicare and Medicaid (CMS) and guidelines set forth by other regulatory agencies, where applicable, and defined in department policies.

Candidate Qualifications

Education

Bachelor’s degree in business, health care or finance preferred.

Experience

Three (3) years’ experience in healthcare planning / operations or business operations focused on accounting or billing.

Skills

Personal computer experience should include working with Microsoft Word, Excel, PowerPoint, and Outlook at the intermediate level.

Professional verbal and written communication skills, with the ability to clearly articulate thoughts and ideas including business requirements and processes.

Organizational skills with the ability to handle multiple tasks and / or projects simultaneously.

Customer service skills with the ability to interact professionally and effectively with providers, third party payers, physicians, and staff from all departments within and outside the organization.

Analytical and interpretation skills including departmental, utilization, financial and operations data.

Decision-making skills with the ability to investigate and weigh alternatives and select the course of action that provides the greatest benefit to the organization

Creative thinking skills with the ability to ask the needed bigger-picture questions that lead to process and team improvements

Time management skills with the ability to prioritize and schedule daily activities for the most efficient use of time

Problem solving skills with the ability to look for root causes and implementable, workable solutions

Interpersonal skills with the ability to work in a fast-paced environment and participate as an independent contributor with little supervision or as an active team member depending on the situation and needs

Must have a track record of producing work that is highly accurate, demonstrates attention to detail, and reflects well on the organization.

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