• MeridianCare Billing & Encounter Specialist

    Job Location US-MI-Detroit
    Job ID
    Medicare Operations
    Business Line
    CMC Corporate
  • Overview

    Who we are:


    Meridian, a WellCare Company, is part of a national network of passionate leaders, achievers, and innovators dedicated to making a difference in the lives of our members, our providers and in the healthcare industry.


    We provide government-based health plans (Medicare, Medicaid, and the Health Insurance Marketplace) in Michigan, Illinois, Indiana, and Ohio.  As a part of the WellCare Family of companies, we deliver healthcare excellence to millions of members nationwide.


    Our associates work hard, play hard, and give back. Meridian associates enjoy an exceptional experience and culture including special events, company sports teams, potlucks, Bagel Fridays, and volunteer opportunities.


    A Day in the Life of a MeridianCare Billing & Encounter Specialist:


    This position is responsible for MeridianCare premium billing, reconciliation and encounter data submission, monitoring, resubmission, and error mitigation along with all other procedures relating to MeridianCare billing and encounters. This position is also responsible for compiling, tracking, interpreting and analyzing the MMP/MMAI enrollment data related to encounter submissions and responses.


    • Responsible for Monthly Membership Report (MMR) reconciliation
    • Responsible for verifying and correcting billing discrepancies
    • Responsible for collecting and transmitting data elements specified by CMS for the purpose of enrollment and disenrollment reconciliation
    • Works closely with EDI to report fall outs of file downloads applicable to Premium Billing and Encounter Data
    • Oversee the preparation, processing and maintenance of encounter data for all MMP/MMAI lines of business
    • Maintain Accuracy, frequency and timeliness requirements for MMP/MMAI encounter submissions and reprocessing
    • Serve as the subject matter expert with Premium Billing, Reconciliation, and encounter data for the organization
    • Prepare monthly billing statements for Medicare members with monthly premiums and late enrollment penalties
    • Identify and execute the necessary process adjustments
    • Identifying and tracking members with potential gaps in creditable coverage and communicating changes with CMS
    • Identify past due situations and tracking delinquency
    • Perform member disenrollments for payment delinquency according to internal process and procedure
    • Distribute the appropriate communication to members as it relates to creditable coverage and LEP
    • Research complex billing problems and recommend solutions
    • Perform monthly revenue reconciliation
    • Maintains strict confidentiality of member information in accordance with Caidan/HIPAA Privacy Policies
    • Prioritizes daily tasks and work items while managing turnaround times and items that require escalation
    • Respond to all inquiries in a timely and professional manner by mail, email, or telephone
    • Conduct appropriate meetings to ensure compliance and processes are developed, created and performed
    • Reports trends and issues to leadership on a weekly basis
    • Performs other duties as assigned


    What you can bring to Meridian:


    • Bachelor’s degree or Fellow designation from the Academy for Healthcare Management (AHM) is required
    • Two to three years of experience in a Managed Care setting is preferred
    • At least one year of experience with Medicare Advantage and Prescription Drug Plans
    • At least one year of experience with reconciling data variances in Medicare Advantage and Prescription Drug Plans
    • At least one year of experience in accounts receivable is preferred
    • At least one year of experience with encounter data is preferred


    What Meridian can offer you:

    • Our healthcare benefits include a variety of plans that are effective on the first day of employment for our new full-time team members. 

    • Opportunity to work with the industry’s leading technologies and participate in unique projects, demonstrations, conferences, and exclusive learning opportunities.

    • Meridian offers 401k matching that is above the national average. 

    • Full-time Meridian employees are eligible for tuition reimbursement towards Bachelor’s or Master’s degrees.

    • Meridian was named Detroit's #1 Fastest Growing Company by Crain's Magazine, so it is a great time to get involved with Meridian. 


      Equal Opportunity Employer




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