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Point32Health Premium Billing Specialist - Medicare in Canton, Massachusetts

Who We Are

Point32Health is a leading health and wellbeing organization, delivering an ever-better personalized health care experience to everyone in our communities. At Point32Health, we are building on the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care, where 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.

We enjoy the important work we do every day in service to our members, partners, colleagues and communities.

Job Summary

Under the general supervision of the Premium Billing Supervisor/Manager, this individual must regularly demonstrate personal resiliency in times of changing direction and also consistently perform routine daily deliverables. The Premium Billing Specialist must be able to plan, organize, and prioritize work to ensure completion in a timely manner. He/she demonstrates an ability to follow business processes, evaluates options when problems arise, and escalates issues appropriately. This individual is expected to learn and understand department processes and their interdependencies, contribute to process enhancement opportunities, and support departmental objectives.

This individual must be able to consistently and accurately review, analyze, and reconcile Electronic Fund Payment (EFT) transactions for our Individual members. The transactions include review and approval of applications, submission of monthly files to the bank for payment/authorization, and member notification.

The Premium Billing Specialist will conduct research to resolve member issues, process adjustments, and post payments. He/she will actively participate in project initiatives, sharing subject matter expertise to achieve business goals. This individual will ensure compliance with CMS/State regulations and internal department processes while supporting the expansion of product offerings and any resulting process changes.

Key Responsibilities/Duties – what you will be doing

Qualifications – what you need to perform the job

EDUCATION:

  • Associates or bachelor's degree preferred; some college required.

EXPERIENCE:

  • Minimum two to four years related business experience, including financial/accounting/bookkeeping.

SKILL REQUIREMENTS:

  • Strong analytical skills, including experience with Microsoft Excel and Microsoft Access

  • Effective communication skills, both verbal and written

  • Ability to perform thorough research, documenting results

  • Ability to become proficient in navigating through internal & external system applications

  • Quick learner

  • Proven time management skills in order to effectively multi-task

  • Demonstrate flexibility 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

  • Experience with Microsoft Office Suite, Lotus Notes E-mail, etc.

WORKING CONDITIONS AND ADDITIONAL REQUIREMENTS

Fast-paced office environment handling multiple demands. Requires that the individual be organized while being readily adaptable to changes in work priorities. Must be able to work independently and in a team environment. May require occasional evening or weekend hours as dictated by the needs of the business.

CONFIDENTIAL DATA: All information (written, verbal, electronic, etc.) that an employee encounters while working at Tufts Health Plan is considered confidential. Will be exposed to and required to deal with highly confidential and sensitive material and must adhere to corporate compliance policy and department guidelines/policies and all applicable laws and regulations at all times.

Commitment to Diversity, Equity & Inclusion

Point32Health is committed to making diversity, equity, and inclusion part of everything we do—from product design to the workforce driving that innovation. Our DEI strategy is deeply connected to our core values and will evolve as the changing nature of work shifts. Programming, events, and an inclusion infrastructure play a role in how we spread cultural awareness, train people leaders on engaging with their teams and provide parameters on how to recruit and retain talented and dynamic talent. We welcome all applicants and qualified individuals, who will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

COVID Policy

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.

At Point32Health, we strive to be a different kind of nonprofit health and well-being company, with a broad range of health plans, and innovative tools that make navigating health and well-being easier, guiding our members at every step of their health care journey to better health outcomes. We are committed to providing high-quality and affordable health care, improving the health and wellness of our members, and creating healthier communities across the country. The Point32Health name is inspired by the 32 points on a compass. It speaks to the critical role we play in guiding and empowering the people we serve to achieve healthier lives. Our employees are hard-working, innovative, and collaborative. They look for opportunities to grow and make a difference, and they help make us strive to be one of the Top Places to work in New England.

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