Premium Billing Specialist- TMP
Watertown , Massachusetts
November 19, 2017

Under the supervision of the THPMP Premium Billing Manager, this individual must be able to consistently and accurately review, analyze, and reconcile all employer group accounts receivable balances on a monthly basis. The Premium Billing Senior Coordinator must independently work with the employer group contacts to establish solid business relationships, resolve discrepancies, and receive appropriate payments within the required timeframe.
The Premium Billing Senior Coordinator is responsible for setting up all employer groups and ensuring they are paying properly and being billed properly. This position will also handle the more complicated member adjustments including members with SSA and LEP/LIS. He/she will actively participate in project initiatives, sharing subject matter expertise to achieve business goals. The resource will 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 demonstrate positive and strong collaboration both within the Premium Billing Team, and across all THPMP departments.

Employer Group Setup and Reconciliation
* Setup new Employer Groups
* Enter group information provided and create necessary rate screens including assigning the appropriate Pharmacy Group Code
* Perform quality check on setup and provide written approval of setup to Internal Audit
* Monthly Reconciliation of Employer Group invoices and payments
* Document discrepancies and send to Employer Group by deadline
* Verify all delinquent Employer Groups, update the delinquency tracker for Sales, term groups who fail to pay premiums
* Answer calls on the Group Line
Member Adjustments
* Review and process adjustments for accounts of members who pay via SSA or have LEP/LIS
* Respond to actiongram requests from CR on these members by the SLA
* Work with Premium Billing Analyst to ensure all adjustments are processed timely
Projects/Other Assignments
* Participate in small to medium projects and workgroups
* Quality check own work and that of others within the department
* Meet production standards for quality and quantity
* Other duties as assigned
* Learn and apply regulatory changes to daily production tasks (Late Enrollment Penalty/Low Income Subsidy/Employer Group Downgrade)
* Actively participate in Corporate Compliance and CMS training (CBTs/Instructor Led Training) within established timeframes
* Review and revise workflows in Support Point as changes to processes happen
* Ensure internal procedures and CMS/State requirements are met

A little about us:
Founded in 1979, Tufts Health Plan is nationally recognized for its commitment to providing innovative, high-quality health care coverage.

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