Internal Auditor

Job Title - Medicare Fulfillment Specialist
Duration - 8 Months
100% Remote

Must Have

• Facets
• Microsoft Office

Job Summary:

Responsible for analyzing and interpreting documentation received in Revenue Cycle from sales, agents, and employer groups to accurately set-up and configure basic to moderately complex fully-funded benefit options, group structures, and membership using the OnBase and Facets systems. Conducts moderately complex analysis of Facets and OnBase information to provide issue resolution and respond to inquiries related to group and member set-up. Assists on project teams as assigned.

Essential Functions:

• Analyze and interpret documentation received from Sales (EGI, NGI, Revisions, Client Fact Sheet, etc.) to determine Facets setup, configuration, and accurately build a variety of fully-funded benefit options, group structures, and enroll members.

• Conduct moderately complex research as necessary to effectively resolve customer issues and respond to customer inquiries regarding group and member status through Facets documentation, phone calls, written correspondence, and approved form letters.

• Participate in cross-functional training opportunities and process improvement initiatives within Revenue Cycle during the non-peak open enrollment periods.

• Works under minimal direction guided by established policies and procedures.

• Analyze multiple reports from various internal and external sources to determine and implement appropriate action to reconcile group/member discrepancies.

• Maintain a basic understanding of all internal and external computer systems and reports that impact the group set-up and member enrollment process.

• Participate in implementation workgroups with Sales and other business owners to ensure a transparent onboarding or renewal process for Key and Performance Guarantee groups.

• Monitors and prioritizes work in the OnBase workflow queues to ensure that our department Service Level Agreements are met.

Qualifications:

• Required High School Diploma or equivalent

• Preferred Associate's Degree in business or health care related field

• 2 years of relevant experience in the healthcare industry or related field Required

• Experience with FACETS Software in benefit and/or group configuration/maintenance or claims Preferred