Eligibility & Revenue Operations Representative
$52,000–$52,000 year
On-siteWorcester, Massachusetts, United States
Job Summary
Provide knowledgeable responses to internal and external inquiries regarding enrollment, billing, and eligibility while maintaining accurate subsidiary accounts receivable. Enter and reconcile membership and billing reports for CMS, MassHealth, and Health Connector, then process transactions and collect premiums for employer groups and individual members. Resolve discrepancies through professional communication, prepare documented payment plans, and manage inventory backlogs by prioritizing daily and weekly work. Maintain current eligibility and premium decisions reviewed by the committee while adhering to CMS and EOHHS regulations.
Required Qualifications
- A verifiable high school diploma or GED
- 4 plus years' experience in an office environment
- preferably in health care and/or managed care system
- Strong analytical and problem-solving skills
- Aptitude towards mathematical fundamentals
- Flexibility in a fast-paced environment
- Excellent Organizational skills/time management
- Strong focus on quality & performance results
- Systems knowledge including but not limited to MS Excel, MS Word, MS Access
- Ability to effectively communicate, both written and verbal
- Builds Relationships/contributes to team performance
- Adhere to all DOI, State, and Federal guidelines
- Excellent communication skills (oral and written)
- Customer Service skills/experience-working with participants and peers
- Computer skills-proficient to advanced typing skills and prior experience with Microsoft Office products
Desired Qualifications
- Bachelor's Degree preferred
- Prior experience working with Medicaid/Medicare
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