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COBRA and Premium Billing Admin I

Company: Univera Healthcare
Location: Rochester
Posted on: January 15, 2022

Job Description:

Summary

Responds to and resolves written, telephone and personal inquiries from clients and/or subscribers concerning policies and procedures in a professional and efficient manner. Coordinates and monitors daily activities for COBRA, Third Party Billing Administration and Medicare Part D to ensure regulatory requirements & established standards and deadlines are met.

Essential Responsibilities/Accountabilities

All Levels

* Maintains COBRA, Association, Retiree and Premium Billing, BlueCare and Medicare Part D databases. Researches and resolves eligibility determinations on behalf of the client.
* Maintains current with changes in COBRA, Premium Billing and Medicare Part D rules and legislation or other relevant changes. Maintains current knowledge of LBS policies and procedures, IRS & DOL regulations governing Cobra rules and regulations and policies and benefits.
* Works with Carriers to assure all billing activities meet the needs of the client and the carrier.
* Assists with new client implementation to establish working relationships and service requirement agreements.
* Performs additional tasks, as necessary, to meet client needs.
* Consistently demonstrates high standards of integrity by supporting the Lifetime Benefit Solution's mission and values and adhering to the Corporate Code of Conduct, and Leading to the Lifetime Way values & Beliefs.
* Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
* Regular and reliable attendance is expected and required.
* Performs other functions as assigned by management.

Focus on Clients/Brokers

* Administers group plans in accordance with all appropriate regulations and process all activity within service time standards. Communicates to clients and provides reports as agreed upon with the client.
* Notifies and educates clients of any rules or regulation changes that affect them.
* Services clients & members in a manner that ensures positive public relations.
* Works closely with Clients and Brokers, as necessary.
* Provides LBS representation at off site Benefit Fairs or perform presentations with established clients, as needed.

Focus on File Processing & Data Protocols

* Answers routine and complex questions, completely and accurately from subscribers, clients, BlueCross BlueShield plans and other areas, either verbal or written. Researches, interprets and responds to inquiries in a professional and efficient manner using problem solving skills.
* Processes membership files including adding, deleting and updating subscriber and group data. Receives and reviews all core enrollment for eligibility based upon underwriting, IRS, DOL and CMS regulations.
* Researches and resolves eligibility determinations on behalf of the client.
* Administers group plans in accordance with all appropriate regulations and process all activity within service time standards.
* Receives, reviews and processes all core enrollment files

Focus on Enrollment & Carrier Reconciliation

* Answers routine and complex questions regarding member enrollment & carrier reconciliation, completely and accurately from subscribers.
* Submits eligibility files to CMS on behalf of client.
* Communicates to clients and provides reports as agreed upon with the client.
* Works with Carriers to assure all billing activities meet the needs of the client and the carrier.
* Maintains membership files including adding, deleting and updating subscriber and group data. eligibility based upon underwriting, IRS and DOL regulations
* Performs reconciliation of account information to assure accuracy of membership and financial records.

Level II - In addition to Level I responsibilities:

* Performs complex research and resolution of inquiries and adjustments under very limited supervision. Plan assignments will include more complex COBRA and Premium Billing plans
* Assignment of large strategic accounts
* Initiates involvement for higher level responsibilities or proactively volunteers for assisting in the resolution of escalated or systemic issues.
* Serves as a resource to other associates.
* Submits eligibility files to CMS on behalf of client.

Focus on Clients/Brokers

* Performs complex research and resolution of inquiries.
* Assists in the resolution of escalated or systemic issues.
* Assignment of large strategic accounts
* Serves as a resource to other associates

Focus on Processing & Data Protocols

* Performs complex research and resolution of inquiries and adjustments under very limited supervision. Plan assignments will include more complex COBRA and Premium Billing plans
* Assists in the resolution of escalated or systemic issues

Focus on Enrollment & Carrier Reconciliation

* Performs complex research and resolution of inquiries and adjustments for carriers.
* Submits eligibility files to CMS on behalf of client.
* Serves as a resource to other associates.

Minimum Qualifications

Note of classification

We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities.

* Associate's degree in business administration or a minimum of three years related experience.
* Expertise in all aspects of rules and regulations for core operations.
* Expertise in hospitalization, medical/surgical, major medical, dental and Medicare benefits.
* Problem solving, reasoning and organizational skills.
* PC experience including knowledge of Word and Excel.
* Oral and written communication skills.

Level II - requires similar qualifications as level I, plus:

* Minimum of five years of experience working in COBRA and Premium Billing environment

Physical Requirements

The Lifetime Healthcare Companies aims to attract the best talent from diverse socioeconomic, cultural and experiential backgrounds, to diversify our workforce and best reflect the communities we serve.

Our mission is to foster an environment where diversity and inclusion are explicitly recognized as fundamental parts of our organizational culture. We believe that diversity of thought and background drives innovation which enables us to provide leading-edge healthcare insurance and services. With that mission in mind, we recruit the best candidates from all communities, to diversify and strengthen our workforce.

OUR COMPANY CULTURE:

Employees are united by our Lifetime Way Values & Behaviors that include compassion, pride, excellence, innovation and having fun! We aim to be an employer of choice by valuing workforce diversity, innovative thinking, employee development, and by offering competitive compensation and benefits.

In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.

Equal Opportunity Employer

Keywords: Univera Healthcare, Rochester , COBRA and Premium Billing Admin I, Accounting, Auditing , Rochester, New York

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