Hours of Operation: M-F 8:30am-5pm, flex schedule as early as 7am Site - Detroit Jefferson Update and maintain accuracy of the membership database. This includes but not limited to: processing enrollment files, analytical and statistical error reports, electronic work queues, membership applications and batches for non-group products and Medigap. Responsible for reviewing, processing and maintaining membership eligibility audits (Medicare, Medigap, ESRD, Public Act 275, COBRA, Medicare Crossover Audits, and member level audits for non-group products). * Coordinate, monitor, and implement changes in accordance with underwriting guidelines for ACA, TEFRA, COBRA and Medicare. * Investigate, research, and resolve discrepancies found in all audits. * Coordinate, monitor, and provide liaison activities internally and externally for resolution of Medicare primary/ secondary payer status and Medicaid. * Investigate and resolve monthly inquiries from Claims and other departments regarding Medicare. Coordinate discrepancies with CMS (member and group level). Coordinate discrepancies with BPCT and MDCH. Generate and distribute membership reports to applicable departments (i.e., Medicare Status Report, etc) * Other duties as assigned by leadership. Work on committees & lead as appropriate. Assist leadership in resolving non-Group eligibility and Medicare questions, and communicate resolutions externally and internally as appropriate. Qualifications * High School graduate or GED required. * Associates Degree or two (2) years of full time college credits in a Business related discipline preferred. * Two (2) years of membership processing required. * Intermediate knowledge of underwriting guidelines required. * Knowledge of current Federal regulations such as ACA, COBRA, TEFRA, Medicare, Medicaid etc preferred. * Extensive knowledge of BCN membership processing systems required. * Possess excellent verbal, written, organizational and problem solving skills. * Ability to manage multiple priorities. * Ability to establish and maintain good working relationships at all levels. * Report writing and preparation skills preferred. * Basic knowledge of Microsoft Word and Excel required. * Data entry requirement of 90NKPM with 90% accuracy required All qualified applicants will receive consideration for employment without regard to, among other grounds, race, color, religion, sex, national origin, sexual orientation, age, gender identity, protected veteran status or status as an individual with a disability.
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