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Henry Ford Health System Membership & Billing Government Enrollment Analyst - Health Alliance Plan in Troy, Michigan

GENERAL SUMMARY:

The Membership & Billing Government Enrollment Analyst position is responsible for ensuring Government Programs membership activity is processed within federally mandated regulations*. Responsibilities include triage escalated billing/enrollment issues, advise management of action to be taken and distribute work to team of specialists, review eligibility discrepancy reports to identify trends, research and document findings regarding compliance issues, track CMS complaints filed by members and work with Sales, Client Services, Finance, and Medicare Operations to ensure customer satisfaction.

  • Membership activity may include Medicare Supplement, Medicare Advantage, Prescription Drug Plans, Medicaid, MMP or on and off-exchange individuals.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

  • Provide oversight for various processes and provide leadership with updates and reports.

  • Analyze all enrollment and payment discrepancies (review FACETS Oracle Compare), including managing workflow of M&B enrollment specialist.

  • Investigate, prepare and submit retroactive enrollment requests to CMS and CMS Contractor.

  • Analyze error reports as assigned, including but not limited to, Daily QA reports, IKA-Facets Compare Report, MEET Error Report, and advise management of trends.

  • Work with IT to resolve system issues and users to update knowledge on current/new processes and procedures.

  • Manage the CMS Delinquency/Cancellation Process

  • Administration of advanced CMS mandated processes such as, BAE, OOA, LEP and Creditable Coverage.

  • Provide back-up assistance for Enrollment Specialists as needed.

  • Research and follow up on member complaints received from CMS regarding Medicare Advantage, from the State regarding Medicaid or MMP and Healthcare Reform contracts

  • Mentor and train staff as needed.

  • Complete other duties as assigned by management.

EDUCATION/EXPERIENCE REQUIRED:

  • High school diploma or equivalent required. Bachelor's degree in Business preferred.

  • Minimum of two (2) years of experience with insurance-related enrollment, disenrollment and premium billing issues.

  • At least one year of experience with Medicare Advantage.

    Overview

    Under the leadership of President and CEO Wright L. Lassiter, III, Henry Ford Health System is a

    $6 billion integrated health system comprised of six hospitals, a health plan, and 250+ sites

    including medical centers, walk-in and urgent care clinics, pharmacy, eye care facilities and

    other healthcare retail. Established in 1915 by auto industry pioneer Henry Ford, the health system

    now has 32,000 employees and remains home to the 1,900-member Henry Ford Medical Group, one

    of the nation’s oldest physician groups. An additional 2,200 physicians are also affiliated with the

    health system through the Henry Ford Physician Network. Henry Ford is also one of the region’s

    major academic medical centers, receiving between $90-$100 million in annual research funding and

    remaining Michigan’s fourth largest NIH-funded institution. Also an active participant in medical

    education and training, the health system has trained nearly 40% of physicians currently practicing

    in the state and also provides education and training for other health professionals including nurses,

    pharmacists, radiology and respiratory technicians. visitHenryFord.com.

    Benefits

    Whether it's offering a new medical option, helping you make healthier lifestyle choices or

    making the employee enrollment selection experience easier, it's all about choice. Henry

    Ford Health System has a new approach for its employee benefits program - My Choice

    Rewards. My Choice Rewards is a program as diverse as the people it serves. There are

    dozens of options for all of our employees including compensation, benefits, work/life balance

    and learning - options that enhance your career and add value to your personal life. As an

    employee you are provided access to Retirement Programs, an Employee Assistance Program

    (Henry Ford Enhanced), Tuition Reimbursement, Paid Time Off, Employee Health and Wellness, and a whole host of other benefits and services. Employee's classified as contingent status are not eligible for benefits.

    Equal Employment Opportunity/Affirmative Action Employer

    Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health System is committed to the hiring, advancement and fair treatment of all individuals without regard to race, color, creed, religion, age, sex, national origin, disability, veteran status, size, height, weight, marital status, family status, gender identity, sexual orientation, and genetic information, or any other protected status in accordance with applicable federal and state laws.
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