Medicare Advantage Premium Billing Analyst

Medicare Advantage Premium Billing Analyst

Ampcus Inc. is a certified global provider of a broad range of Technology and Business consulting services. We are in search of a highly motivated candidate to join our talented team.

Location(s): Los Angeles, CA (Remote)

Job Summary: We are seeking an experienced Medicare Advantage Premium Billing Analyst to support premium billing, enrollment, and reconciliation activities for a Medicare health plan. The ideal candidate will have experience working with State (California) and CMS files and possess a strong understanding of Medicare enrollment operations, premium billing, payment reconciliation, and regulatory requirements. This role is responsible for investigating payment discrepancies, resolving member inquiries, and ensuring accurate enrollment and billing processes.

Key Responsibilities:

• Process and analyze Medicare Advantage premium billing activities.
• Review and reconcile State (California) and CMS enrollment and billing files.
• Investigate and resolve premium payment discrepancies and billing issues.
• Respond to and resolve member billing and enrollment inquiries.
• Perform enrollment, disenrollment, and reconciliation activities in accordance with Medicare regulations.
• Validate member eligibility and enrollment information.
• Maintain accurate billing records and documentation.
• Ensure compliance with CMS and Medicare regulatory requirements.
• Collaborate with internal departments to resolve billing and enrollment issues.
• Identify process improvement opportunities to enhance billing accuracy and efficiency.

Required Qualifications:

• High School Diploma or equivalent.
• Minimum of 35 years of experience in a Medicare health plan or Managed Care environment.
• Experience with Medicare Enrollment, Disenrollment, and Reconciliation processes.
• Experience working with State (California) and CMS enrollment/billing files.
• Strong knowledge of Medicare Advantage enrollment and premium billing operations.
• Thorough understanding of CMS enrollment and billing regulatory requirements.
• Experience investigating and resolving payment discrepancies.
• Strong analytical and problem-solving skills.
• Excellent attention to detail and organizational skills.
• Proficiency with Microsoft Office, particularly Excel.
• Strong written and verbal communication skills.
• Ability to work independently in a remote environment while managing multiple priorities.

Preferred Qualifications:

• Experience supporting Medicare Advantage premium billing operations.
• Knowledge of finance, accounting, bookkeeping, and billing principles.
• Experience working with Medicare membership enrollment systems.
• Familiarity with reconciliation reporting and audit processes.

Work Schedule:

• Monday Friday, 8:00 AM 5:00 PM

Ampcus is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veterans or individuals with disabilities.