Account Administrative Representative

Job Summary:

To work as a team member of the California Service Center (CSC) which is responsible for Membership Accounting and Contracts Administration functions for the California Division. The overall objectives of this position are to perform account maintenance, billing, reconciliation, reporting, and customer service related activities.

Duties also include performing database maintenance and research tasks to support contracts administration, cash control operations, and assignment of medical record numbers. This includes generating and distributing contracts and member I.D. cards, providing facilities support, and entering documents into the workflow imaging system.

Essential Responsibilities:

• Identifying, researching, and reconciling billing payment amounts to ensure accurate eligibility determination, payment, revenue, and membership records.
• Setting up and maintaining member data including processing enrollments, corrections, retroactivity adjustments, and terminations.
• Supporting eligibility inquiries.
• Ensuring bills are correct and mailed timely.
• Interacting with purchaser benefit administrators to answer questions and explain Health Plan policy and contractual provisions related to membership and billing.
• Resolving related problems.
• Assisting Health Plan purchaser contacts and sales and service representatives in the sales process and the analysis and resolution of problems related to membership accounting.
• Conducting audits of purchasers with large payment variances, unallocated payments, or other specified criteria.
• Resolving payment discrepancies and delinquencies.
• Ensuring purchasers compliance with Health Plan policies and contractual provisions.
• Preparing reports and managing purchaser correspondence.
• Receiving, entering data, reviewing, researching, balancing, and applying daily purchaser deposits and sources from the bank in a timely and accurate fashion.
• Assisting with the production and distribution of payment-related reports required by purchasers and management.
• Supporting Medicare processing and reporting requirements.
• Ensuring that changes to contracts are quickly and accurately updated in the contract systems.
• Assisting with the production and distribution of contracts and related notices for new and renewing purchasers and individuals.
• Answering, researching, issuing, and resolving problems related to medical records numbers (MRN) and performing any required follow-up activities on a 24-hour per day, 7-day a week basis.
• Processing purchasers eligibility reported electronically by coordinating the exchange of media with groups and Information Services.
• Identifying, coding, batching, scanning, and indexing documents for imaging.
• Providing office services support including picking up, sorting, and delivering mail, filing and retrieving documents, ordering and distributing office supplies, and performing miscellaneous facilities maintenance tasks.
• Working with internal and external customers and vendors to resolve any issues related to support services activities.
• Collecting and monitoring productivity and customer service quality measures.
• Participating in team-based projects and contributing to customer service and operations improvements initiatives.
• Assisting with training as required.
• Facilitating communications across all lines of business and with other departments.
• Participating in purchasers performance evaluations and performance target setting activities.
• Performing other duties as assigned.

Basic Qualifications:

Experience:

• N/A.

Education:

• N/A.

License, Certification, Registration:

• N/A

Additional Requirements:

• Proficiency in math, data entry, typing, spelling, and grammar, for which tests are required.
• Demonstrated ability to work in a team-based environment.
• Successful customer service track record.
• Ability to diagnose, analyze, and solve a variety of quantitative and qualitative problems.
• Ability to communicate clearly and professionally.
• Computer experience preferably in a PC Windows-based environment.
• Willing to learn new tasks and adapt to new business requirements.
• Excellent conflict resolution and decision-making capabilities.
• Ability to work productively at multiple tasks.
• Ability to adapt to change and be flexible in shifting priorities.

Preferred Qualifications:

• Minimum of two (2) years experience in accounting, finance, or related field preferred.
• Experience with operations of peripheral equipment, such as printers or magnetic tape equipment, and knowledge of operating systems commands such as MVS/ESA and JES2 mainframe application preferred.
• Experience with mainframe application and computer transaction processing preferred.