Enrollment and Billing Rep I
Posted on: February 10, 2020
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PacificSource is an equal opportunity employer. All qualified
applicants will receive consideration for employment without regard
to status as a protected veteran or a qualified individual with a
disability, or other protected status, such as race, religion,
color, national origin, sex, sexual orientation, gender identity or
Diversity and Inclusion: PacificSource values the diversity of the
people we hire and serve. We are committed to creating a diverse
environment and fostering a workplace in which individual
differences are appreciated, respected and responded to in ways
that fully develop and utilize each person's talents and
Position Overview: This position follows established policies and
procedures to process a multitude of transactions for Government
line of business including but not limited to:
- Demographic Updates
- Notification Letters
- Plan Changes
- Process daily returned mail, making any related changes in EAM
& Facets contacting the member if needed, and resending documents
or processing as required by CMS.
- Manually create and send Out of Area letters to members who may
have moved out of the service area. Research, make changes, and/or
complete any Call Tracks regarding enrollment/membership in
- Respond to any inquires received via phone calls, e-mails, etc,
researching or providing info needed or making any necessary
changes to member files as needed for the Government line of
- Add or correct member data in our pharmacy vendor
- Process all Medicare membership enrollment, plan changes,
facilitated enrollments and reinstatements.
- Review the daily EAM Validation report and make corrections as
- Process all Medicare membership cancellation of enrollments,
cancellation of disenrollment's and death notifications.
- Process the CMS Enrollment Data Verification monthly audit for
address and enrollment updates.
- Answer Queue Customer Service calls for Medicaid/Medicare
members regarding eligibility.
- Submit miscellaneous transactions to CMS daily as needed.
- Respond to insurance verification requests for Medicare
- Perform scanning and key wording of ROI's/POA's in to Onbase
for the Government line of business.
- Load ROI/POA documentation in to Facets.
- Work the monthly P2P report for Accounts Payable Download CMS
applications, upload electronic applications in to EAM, save
applications and perform indexing of applications in onbase.
- Process all Medicare COB. Send COB letters to members, update
Facets and the COB database and submit member information backs to
- Follow company and department policies.
- Meet department and company performance and attendance
- Provide backup support for other members of the enrollment
- Ability to judge severity of problems and the need to escalate
to peers and/or management.
- Support and participate in continuous improvement
- Maintain professional, service oriented relationships.
regulations concerning confidentiality and security of protected
- Perform other duties as assigned.
- Minimum 2 years of administrative experience with at least 1
year in health insurance billing or related healthcare experience
- Demonstrated ability to work efficiently and effectively with a
high attention to detail.
Education, Certificates, Licenses: High School Diploma or
- Ability to understand and interpret Federal and Oregon State
laws and contract provisions.
- Proficiency in Microsoft Applications.
- Demonstrated organizational and time management skills.
- Requires keyboarding and 10-key skills.
- Experience with problem solving and ability to read system
- Building Customer Loyalty
- Building Strategic Work Relationships
- Contributing to Team Success
- Planning and Organizing
- Continuous Improvement
- Building Trust
- Work Standards
Environment: Work inside in a general office setting with
ergonomically configured equipment.
- We are committed to doing the right thing.
- We are one team working toward a common goal.
- We are each responsible for customer service.
- We practice open communication at all levels of the company to
foster individual, team and company growth.
- We actively participate in efforts to improve our many
communities-internally and externally.
- We encourage creativity, innovation, and the pursuit of
Physical Requirements: Stoop and bend. Sit and/or stand for
extended periods of time while performing core job functions.
Repetitive motions to include typing, sorting and filing. Light
lifting and carrying of files and business materials. Ability to
read and comprehend both written and spoken English. Communicate
clearly and effectively.
Disclaimer: This job description indicates the general nature and
level of work performed by employees within this position and is
subject to change. It is not designed to contain or be interpreted
as a comprehensive list of all duties, responsibilities, and
qualifications required of employees assigned to this position.
Employment remains AT-WILL at all times.
Keywords: PacificSource, Bend , Enrollment and Billing Rep I, Accounting, Auditing , Bend, Oregon
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