Premium Billing Representative

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.

The Premium Billing Representative manages the premium billing activities for the enrollment department. Premium billing includes producing and sending monthly statements, reviewing payments made, reconciling and collecting outstanding accounts. This position serves as the first point of contact for questions from individuals regarding premium invoices. In addition, the PBA is responsible for maintaining the Centers of Medicare and Medicaid Services (CMS) timeliness, quality standards, policies and procedures. Assists with establishing and maintaining interdepartmental workflow, developing and implementing policies to improve the quality, timeliness and accuracy of information, throughout the organization and for providing reporting and data validation services.

GENERAL DUTIES/RESPONSIBILITIES:
1.    Reconciles premium payments from members.
2.    Identifies and resolves premium payment discrepancies.
3.    Answers questions from individuals and third-party vendors.
4.    Prepares and submits monthly premium invoices to individuals either electronically or by paper.
5.    Follows and reports status of delinquent accounts.
6.    Analyzes data as it pertains to member premiums.
7.    Maintains all information regarding membership premiums in the membership system.
8.    Process’ member premium billing for Alignment Healthcare product lines.
9.    Maintains required tracking/reporting.
10.    Defines and produces process reports for the operation of the department including but not limited to the complete processing of change requests, result reporting and overall departmental performance reporting.
11.    Manages record and electronic data archive and storage and quality control for the retention of these key documents/records.
12.    Performs other duties as assigned.

Job Requirements:

Experience:

• Required: Minimum 1-year experience in a health maintenance organization (HMO)

• Preferred: Experience with HMO or Medicare Advantage Prescription Drug Plan (MA-PD) preferred. 2 years’ experience with financial analysis, accounts receivable, and / or premium billing preferred

Education:

• Required: High School Diploma or GED.  

• Preferred: Bachelor’s Degree

Specialized Skills:

• Required:

• Proficiency with Microsoft Office Suite of products (Word, Excel, Access, etc.)
• Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others.
• Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors;
• Language Skills: Able to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals.  Ability to write routine reports and correspondence.  Able to speak effectively before groups of customers or employees of the organization.
• Mathematical Skills: Able to add and subtract two-digit numbers and to multiply and divide with 10’s and 100’s.  Ability to perform these operations using units of American money and weight measurement, volume, and distance.
• Reasoning Skills: Able to apply common sense understanding to carry out detailed but uninvolved written or oral instructions.  Ability to deal with problems involving a few concrete variables in standardized situations.
• Computer Skills: Basic skills required.

Licensure:

• Required: None

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1.  While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.

2. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

Pay Range: $41,600.00 - $57,600.00

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email careers@ahcusa.com.

Salary : $41,600 - $57,600