Medicare Enrollment & Billing Specialist

Job Description

Job Description

Company Overview:

Join us in our mission to transform healthcare! nirvanaHealth (under RxAdvance Corp.) is committed to bringing the art of the possible to the payer and PBM industries. We invest in our employees at every stage of life. Success radiates across all levels of our organization, driven by competitive benefits and a strong focus on employee wellness, we aim to support all aspects of employee growth.

Characterized by curiosity, innovation, and an entrepreneurial mindset, nirvanaHealth is the first to offer medical and pharmacy benefit management solutions that run on the same platform, made possible by our creation, Aria – the first robotic process automation cloud platform designed for healthcare.

Under the leadership of our Chairman John Sculley, former Apple CEO, and our President & CEO Ravi Ika, nirvanaHealth endeavors to sizably reduce the $1 trillion in waste in healthcare administrative and medical costs. We are seeking self-determined players to join our team – folks who embrace the grind and hustle of a growing company, are collaborative and innovative, are life-long learners and growers, and have an entrepreneurial and positive mindset.

Job Summary:

The Medicare Billing & Enrollment Specialist is responsible for the enrollment, disenrollment, and billing process for Medicare Advantage Plans. They will provide key support across the organization in areas including but not limited to eligibility, billing, general operations, and data management.

Job Responsibilities (but not limited to):

• Prepare and submit Medicare invoices using appropriate billing codes and procedures.
• Generate, review, and analyze billing reports to monitor the status of payments.
• Maintain detailed records of billing activities and communications.
• Stay informed about and ensure adherence to Medicare regulations, billing practices, and guidelines to avoid any discrepancies.
• Act as a liaison between Medicare representatives, healthcare providers, and patients.
• Process enrollments and disenrollments, while providing key support across the organization to other departments involved in the eligibility.
• Maintain meticulous records of all enrollments, disenrollments, and payments ensuring that all documentation is accurate and easily accessible
• Document pertinent information enabling tracking of group/subscriber/member and eligibility and adheres to internal and external SLA’s.
• Educate consumers who contact nirvanaHealth about Medicare products of the plans we are servicing.
• Provide knowledgeable response to internal and external inquiries and concerns regarding enrollment and billing including, but not limited to, qualifying events, policies and procedures, ID cards, letter correspondence (including Outbound Education and Verification), selection of primary care physician, premium invoices, payment inquiries and general eligibility and financial maintenance.
• Develop a deep level of trust for Medicare members, understanding their needs, engaging the members on how the plan can best support them & their families, and orchestrating the initial enrollment with our team.
• With speed, accuracy, and integrity, ensure that enrollee data for Medicare Advantage, Medicare Supplement, and any future regulatory products is entered into nirvanaHealth’s system.
• Reconcile membership and billing reports as required by CMS, MassHealth and Employer groups (both automated and manual) to ensure accuracy of information.
• Appropriately escalates concerns when necessary and follows issues through to closure.
• Responsible for processing payment files received from online payment vendor.
• Analyze/reconcile receivables balance for Regulatory products to identify problems with payments and/or impose the delinquency process.
• Processes all transactions related to customer data in a timely and accurate manner. Escalates inventory backlog daily

Education and/or Training:

• High School Diploma or equivalent degree required.
• Bachelor’s degree is preferred, or equivalent relevant experience in Medicare Billing & Enrollment Services.

Professional Experience:

• 0 - 1 year of Medicare enrollment experience preferred.
• Prior experience working in a health plan is preferred.
• Knowledge of Medicare eligibility, as well as the Medicare Advantage Prescription (MA-PD) enrollment processing required.
• Familiarity with Medicare billing processes preferred.
• Knowledge of billing guidelines.
• Excellent communicator with an uplifting, and personable manner with outstanding phone etiquette.
• Excellent written communication skills with success in providing notes, updates, and written communications via computer systems.
• Excellent data-entry skills and proven ability to navigate multiple computer screens.