SME-Enrollment & Billing

Job Summary

Serve as a subject matter expert in enrollment and billing for a leading global payer organization applying strong MS Office proficiency and deep understanding of HIPAA to support accurate member data management timely premium processing and compliant reporting in a hybrid night shift role that ensures high quality service and operational excellence.

Responsibilities

• Manage end to end enrollment and billing activities for payer member accounts ensuring timely and accurate onboarding updates and terminations to support uninterrupted coverage and premium collection.
• Analyze enrollment and billing data using MS Office tools to identify discrepancies trends and root causes then document findings clearly to support corrective actions and process optimization.
• Validate member eligibility plan selections and premium calculations against payer business rules and regulatory requirements to maintain data integrity across core systems.
• Coordinate closely with operations configuration and finance teams to resolve enrollment and billing issues promptly minimizing revenue leakage and impact on member experience.
• Create and maintain detailed process documentation job aids and reference materials for enrollment and billing workflows that help standardize practices across hybrid team members.
• Prepare recurring and ad hoc reports in spreadsheets and presentations that summarize enrollment volumes billing status and aging items to inform management decisions.
• Apply HIPAA knowledge to safeguard protected health information in all enrollment and billing activities including secure handling of files emails and system access practices.
• Respond to complex internal inquiries related to member enrollment status premium payments and adjustments explaining resolution steps clearly and setting realistic expectations on timelines.
• Support quality assurance reviews by providing transaction level details clarifications and evidence and implement agreed remediation steps to improve accuracy and compliance.
• Contribute to continuous improvement initiatives by suggesting practical enhancements to templates macros and validation checks in office productivity tools that reduce manual effort and errors.
• Collaborate with training and operations stakeholders to onboard new team members in night shift sharing domain insights on payer specific enrollment and billing nuances through structured walkthroughs.
• Monitor daily work queues and service level commitments prioritizing high impact enrollment and billing tasks to ensure timely completion and positive impact on member satisfaction.
• Participate in periodic audits and internal reviews related to enrollment and billing processes providing transparent responses and supporting documentation that demonstrate strong control adherence.

Qualifications

• Possess three to four years of hands on experience in payer domain enrollment and billing operations including member data maintenance premium processing and adjustment handling.
• Demonstrate strong practical proficiency in office productivity software for data analysis reporting documentation and communication within a fast paced operations environment.
• Exhibit sound working knowledge of HIPAA regulations as they relate to enrollment and billing applying privacy and security principles consistently in daily work.
• Show proven ability to interpret payer plan rules benefit structures and billing modalities translating them into accurate system updates and calculations.
• Display effective written and verbal communication skills suitable for night shift collaboration with cross functional teams and stakeholders.
• Maintain high attention to detail numerical accuracy and problem solving aptitude when handling large volumes of enrollment and billing transactions.
• Adapt well to a hybrid work model using secure remote access and collaboration tools to maintain productivity compliance and service quality without travel requirements.