Eligibility and Revenue Financial Support

About us:

Fallon Health is a company that cares. We prioritize our members-always-making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, Fallon Health delivers equitable, high-quality, coordinated care and is continually rated among the nation's top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge, self-expression, and unique capabilities allow us to better serve our members. We embrace and encourage differences in age, race, ethnicity, gender identity and expression, physical and mental ability, sexual orientation, socio-economic status, and other characteristics that make people unique. Today, guided by our mission of improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs-including Medicare, Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)- in the region. Learn more at fallonhealth.org or follow us on Facebook, Twitter and LinkedIn.

Brief summary of purpose:

Under the direction of the Manager, Eligibility and Revenue Financial Support will work to support Fallon Health's mission, vision, and values by providing and maintaining timely and accurate premium billing information. Responsibilities include but are not limited to the overall understanding and operation of the Premium Billing department to ensure the accurate processing of bill runs, collections, adjustments, and reconciliations. Reconciliation of subsidy payments from members, CMS, State of MA, and State of NY. Processing of adjustments recorded from member's accounts and discrepancy reporting and resolution. Process late notices and cancellations in accordance with CMS guidelines. Serves as SME for testing of core system upgrades. Works with staff to review & enhance current workflows related to AR processing within the core system. Assists the department Sr. Director and Manager in maintaining newly created metrics to ensure timely and accurate maintenance of receivable balances.

The Eligibility and Revenue Financial Support will complete work accurately and timely to remain in compliance with DOI, CMS and EOHHS regulations. Appropriately escalates concerns when necessary and follows issues through to closure. Problems not clearly defined by written directives or instructions are reviewed with the Manager, or Sr. Director to determine course of action.

The Eligibility and Revenue Financial Support collaborates effectively with co-workers and other departments to ensure quality service to our internal and external customers. This includes maintaining a positive approach to issues and concerns as they arise and works to identify and recommend process improvements to the direct supervisor/manager. Responsible for ensuring the integrity of information being entered & maintained within the QNXT system. Must be able to analyze various situations and make independent decisions on best practices in the interest of the members and the health plan.

Pre-requisites for success in this position include strong verbal & written communication skills including demonstrated excellence in telephone communication, strong organizational skills, and computer skills. Performs all functions necessary to maintain accurate subsidiary accounts receivable and ensure accuracy of premium bills. Reconciles employer group bills to group payment listings or direct pay member bills, and appropriately research. Process 820 payment files into the core system. Reviews monthly Accounts Receivable Summary and Aged Trial Balance to identify problems with payments. Works collaboratively with the leadership team to ensure completion of monthly and yearly subsidiary accounts receivable and premium billing reports.

Handles confidential customer information. Knowledge of plan policies, protocols, and procedures. Requires ability to work in a fast-paced environment with multi-disciplined staff. Consistent follow-through on issue resolution and strong multitasking abilities are essential along with taking accountability and understanding job functions can change based upon the business need. Initiates self-development via available company and industry educational opportunities.

The Eligibility and Revenue Financial Support is responsible for premium billing maintenance, adhering to daily, weekly, and monthly schedules and administrative related tasks.

Primary Job Responsibilities:

Maintains receivable balances & Learning/Development
• Responsible for production of all standard Daily and Month End reporting utilized by the Financial Senior Analyst; including but not limited to Accounts Receivable Summary, Aged Trial Balance, Credit, and balance forward reporting.
• Research accounts for refunds and adjustments, verifying for accuracy and compliance to established policies and procedures.
• Process, on a daily basis, ACH, CC, wire, returns, and payment batches in core system.
• Log payments received in-house from customers and deliver to Finance for deposit.
• Coordinates the accurate and timely production of all Premium Bill runs with outside Vendor, Cathedral, and Invoice Cloud.
• Reviews accounts for refunds and adjustments, verifying for accuracy and compliance with established policies and procedures.
• Posts 820 payment files received from State and Federal entities to members accounts.
• Processing of daily Lockbox and Invoice Cloud payment file.
• Prepare payment breakdown sheets to be sent to Finance for accurate recording of cash received.
• Ensure accuracy of premium payments posted on customers' subsidiary accounts.
• Work with termed accounts on outstanding balances prior to sending them to collection agency.
• Work with the collection agency regarding delinquent accounts.
• Enters and maintains premium rates received from the State or CMS in the core system.
• Works proactively to ensure premium billing records are kept current and are accurate.
• Work with Financial Senior Analyst in the validation of the wire log and premium wash account.
• Assist in testing updates made to financial reporting from the core system.
• Works with management team for creation of updated workflows related to accounts receivable processing.
• Works with QA on the creation/maintenance of desk top procedures and P & P's.
• Ensure newly created financial metrics are met.
• Assists Management team on audit responses and/or site visits.
• Participate in departmental and company-wide process improvement projects, training, testing and team meetings as assigned.
• Works department returned mail.
• Provides detailed analyses and explanations of all transactions to Enrollment and Billing Director/Manager and COO as requested.
• Performs other duties as they are assigned to meet department performance goals and to respond to changing priorities including administrative related tasks.
• Additional duties may be assigned or requested by the Director or Manager.

Experience:

• 5 plus years' experience in an office environment, preferably in health care and/or managed care system
• Financial background; Premium Billing experience a plus
• Strong analytical and problem-solving skills
• Flexibility in a fast-paced
• Excellent Organizational skills/time management
• Strong focus on quality & performance results
• Systems knowledge including but not limited to MS Excel, MS Word, MS
• Ability to effectively communicate, both written and
• Builds Relationships/contributes to team performance
• Respond to all audit requests timely
• Adhere to all DOI, State, and Federal guidelines

Pay Range Disclosure:
In accordance with the Massachusetts Wage Transparency Act, the pay for this position is $27.00 per hour which reflects what we reasonably and in good faith expect to pay at the time of posting. Final compensation will depend on the candidate's experience, skills, and fit with the role's responsibilities.

Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.