Job Number: 2007

Workplace Type:

Position Title: Manager, Premium and Eligibility

External Description:

Summary

This position is responsible for managing the Premium Billing and the daily operations activities for the Eligibility Department.  The Manager is to oversee Premium billing includes producing and sending monthly statements, reviewing payments made, reconciling and collecting outstanding accounts collaboration with DTS and the third party vendor. In addition, the manager is responsible for managing the eligibility staff and ensuring to monitor calls and generate department reports.  Provide Alignment Healthplan’s internal departments, employee/partner and contracted providers in obtaining proper member PCP and eligibility information. As well as maintaining the Centers of Medicare and Medicaid Services (CMS) timeliness, quality standards, policies and procedures.

Essential Duties and Responsibilities

Essential duties and responsibilities include, but are not limited to:

1. Reconcile premium payments from members.
2. Identifies and resolves premium payment discrepancies
3. Answers questions from individuals and third party vendor
4. Collaborate with DTS to create and implement systems to improve workflows, tracking, reporting,.
5. Collaborate with any third party vendors.
6. Prepares and submits monthly premium invoices to individuals. Either electronically or by paper
7. Follows and reports status of delinquent accounts
8. Responsible for analyzing data as it pertains to member premiums
9. Responsible for maintaining all information regarding membership premiums in the membership system
10. Responsible for processing member premium billing for AHC product lines
11. Maintain required tracking/reporting
12. Responsible for defining and producing process reports for the operation of the department including but not limited to the complete processing of change requests, result reporting and overall departmental performance reporting
13. Responsible for record and electronic data archive and storage, and for quality control for the retention of these key documents/records
14. Understands and abides by all departmental policies and procedures.

1. Supervise the daily process of all regular and retro PCP transfers as completed by the Member Services Staff and report all changes on a monthly basis to Alignment Healthplan subcontracted providers
2. Will assist with creating department policies and procedures as needed to ensure the department is in accordance with CMS guidelines.

1. Development and implementation of programs with direct effect towards the Eligibility Department.

1. Maintain all eligibility files within the Alignment Healthplan’s shared drive.
2. Manages all lines of eligibility reconciliation.
3. Submit daily eligibility files to PBM and Mail house vendor.
4. Submits monthly reports to the Director.
5. Monitors staff attendance and performance.

1. Perform all other duties as requested by Management

Supervisory Responsibilities

Directly oversees department staff in respective units. Carries out supervisory responsibilities in accordance with organization policies and applicable laws.  Responsibilities include training of employees; planning, assigning and directing work; assisting in the rewarding and disciplining of assigned employees; addressing complaints and resolving problems as they pertain to respective units.

 

 

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  The requirements listed below are representative of the knowledge, skill, and/or ability required.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Bachelor’s degree or equivalent work experience (5 years) background in insurance or managed care preferably in a project management or quality improvement department.  

1. Minimum 2-5 years in a Health Maintenance Organization HMO or Medicare Advantage
2. Minimum 2-5 years in Accounting experience (financial records)
3. 5 year experience with accounts receivable and/or premium billing preferred
4. Experience with CMS requirements for premium billing
5. Strong sense of excellent customer service
6. Strong written communication skills
7. Proficient data entry skills
8. Proficiency with Microsoft Office (Word, Excel, Access)
9. Ability to complete tasks in a timely manner
10. Strong organizational skills
11. Ability to communicate effectively
12. Good organizational skills
13. Ability to prioritize
14. Self-starter and able to work independently
15. Excellent problem solving skills

Skills and Abilities

1. Language Skills:  Ability to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals.  Ability to write routine reports and correspondence.  Ability to speak effectively before groups of customers or employees of the organization.
2. Mathematical Skills:  Ability to add and subtract two digit numbers and to multiply and divide with 10’s and 100’s.  Ability to perform these operations using units of American money and weight measurement, volume, and distance.
3. Reasoning Skills:  Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions.  Ability to deal with problems involving a few concrete variables in standardized situations.
4. Computer Skills:  Basic skills required.
5. Other Skills and Abilities:
6. 1. Good organizational skills.
   2. Ability to reason and carry out instructions.
   3. Good interpersonal skills.
   4. Ability to type 45+ words per minute.
   5. File systematically.
   6. Self-motivation.
   7. Strong Customer Services skills.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear.
2. The employee is frequently required to reach with hands and arms.
3. The employee is occasionally required to stand; walk; climb or balance and stoop, kneel, crouch, or crawl.
4. The employee must occasionally lift and/or move up to 30 pounds.
5. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.

Working Environment 

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

City: Orange

State: California

Location City: Orange

Location State: California

Community / Marketing Title: Premium and Eligibility Manager

Company Profile:

By leveraging our world-class technology platform, innovative care delivery models, deep physician partnerships and our serving heart culture, Alignment Health is revolutionizing health care for seniors! From member experience professionals and clinicians, to data scientists and operations leaders, we have built a talented and passionate team that is deeply committed to our mission of transforming health care for the seniors we serve. Ready to join us?

At Alignment, delivering exceptional care to seniors starts with ensuring an exceptional experience for our over 1,300 employees. At the center of our employee experience is a culture where employees at all levels and across all teams are encouraged to share their unique ideas and perspectives. After all, when you can bring your authentic self to work, whether that’s in a clinical setting, our corporate office or a home office, creativity and innovation flourish! Another important part of the Alignment culture is a belief in continuous learning and growth. As a result, in this fast-growing company, you will find ample support to grow your skills and your career – with us.

EEO Employer Verbiage:

 

Please note: All clinical positions are contingent upon successful engagement with Alignment Health’s COVID-19 Vaccination program (fully vaccinated with documented proof or approved exception/deferral).

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email [email protected].