Premium Billing Team Lead - Medicare Ops

Under the supervision of the Point32Health Medicare Premium Billing Manager, this individual will serve as Team Lead for the Premium Billing team.  S/he is responsible for Macess distribution and tracking.  The Team Lead will also monitor quality controls and team members’ progress to advise Manager of areas of opportunity or improvement.  The Team Lead will also support the Manager by running invoices, delinquency letters, and Intent to Terms.  S/he will act as SME (Subject Matter Expert) for the entire Premium Billing team.  The Team Lead will also actively participate in project initiatives sharing subject matter expertise to achieve business goals; ensure compliance with all CMS & State regulations and internal department processes while fully supporting the expansion of production offerings and process changes as a result of such.

He/she must be able to proactively escalate issues, identify areas of process improvement, and to support collaboration both within the Premium Billing Team, and across all Point32health Medicare departments.

KEY RESPONSIBILITIES/ESSENTIAL FUNCTIONS

Team Lead 

• Participation in training of  staff as applicable
  
• Daily oversight of the team, serving as Subject Matter Expert (SME) and point person for escalated issues
• Management of daily team workload; ability to reprioritize tasks and reallocate resources as needed
• Identify and communicate any production/personnel issues to Manager
• Ability to run, read, and analyze Operations reporting
• Act as “Covering Manager” during Supervisor’s absence

Macess Reconciliation

• Intake, organize, and distribute Macess action-grams to Premium Billing staff
  
• Perform reconciliation and quality control review action-gram response times
• Update Manager on any identified trends

Invoice, Delinquency, Intent to Term Processing

• Run monthly invoice, delinquency and intent to term files. 
  
• QC and correct invalid member records

Compliance

• Learn and apply regulatory changes to daily production tasks (i.e. transaction code changes, product offerings, re-issuance of guidance)
  
• Complete checklist to ensure all necessary documentation is included
• Proactively identify any deficiencies notifying Manager, Senior Financial Analyst, and Compliance Analyst
• Actively participate in Corporate Compliance and CMS training (i.e. CBTs, instructor-lead training) within established timeframes
• Review and/or revise department policy & procedures based on subject matter expertise
• Ensure internal procedures and CMS/State requirements are met

Requirements

EDUCATION: 

• Associates degree or  Bachelors degree preferred (i.e. Business Administration/Management, Healthcare concentration, etc.)
  

EXPERIENCE:  (Years of experience)

• Minimum 2-5  years related business experience. Financial reporting or accounting a plus
  

SKILL REQUIREMENTS: (Include interpersonal skills)

• Proven ability to lead/co-lead permanent and temporary staff as assigned
  
• Effective communication skills (verbal, written). 
• Ability to independently handle escalated issues
• Ability to perform thorough research and analysis, documenting results, and communicating to various audiences
• Quick learner
• Demonstrated attention to detail, achieving a high degree of accuracy
• Strong time management skills in order to effectively multi-task while meeting established deadlines
• Proficient in usage of Microsoft Office Excel, Microsoft Access knowledge a plus
• Ability to become proficient in navigating through internal & external system applications
• Demonstrate flexibility, commitment, and resiliency in times of business and organizational change
• Demonstrate professional demeanor at all times
• Support collaboration across Membership Operations and other departments and work cooperatively as a team member
• Provide/accept constructive criticism for improvement, including peer and Manager feedback for performance. Coach others to do so as well.

What we build together changes our customer's health for the better. We are looking for talented and innovative people to join our team. Come join us!

Please note: As of January 18, 2022, all employees — including remote employees — must be fully vaccinated. This position will require the successful candidate to show proof of full vaccination against COVID-19. Point32Health is an equal opportunity employer, and will consider reasonable accommodation to those individuals who are unable to be vaccinated consistent with federal, state, and local law.

About Us:

Point32Health is a leading health and wellbeing organization, delivering an ever-better health care experience to everyone in our communities. Building on the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care, we leverage our experience and expertise to help people find their version of healthier living through a broad range of health plans and tools that make navigating health and wellbeing easier.

At Point32Health, we’re working to reshape the world of health care by pushing past the status quo and delivering even more to the diverse communities we serve: more innovation, more access, more support, and healthier lives. And we want people like you on our side to make it even better.

This job has been posted by TalentBoost on behalf of Point32Health. TalentBoost is committed to the fundamental principle of equal opportunity and equal treatment for every prospective and current employee. It is the policy of TalentBoost not to discriminate based on race, color, national or ethnic origin, ancestry, age, religion, creed, disability, sex and gender, sexual orientation, gender identity and/or expression, military or veteran status, or any other characteristic protected under applicable federal, state or local law.