Gateway Specialist
Independence Blue Cross · Philadelphia, PA · 2 wk ago
OTHRFull-time
Responsibilities
- Have an understanding of how to update manual enrollment transactions in Health Rules/Proof.
- Have a basic understanding of ACA Consumer business and basic CMS, and Compliance Regulations.
- Review complex outbound CMS files (including 834, 820, pre-audit, and RCNI/Discrepancy files) to develop best practices for analysis, reconciliation automation, and resolution.
- Successfully manages the flow of inbound and outbound electronic files being received through the Gateway/mPulse from a variety of vendors or government entities (IBX Portal, mPulse Retail, Pennie, Get Covered NJ, and Edifecs).
- Analyze enrollment fallout/discrepancies and make the appropriate update in mPulse or appropriately triage to the manual enrollment team for updates in Health Proof/CFI.
- Processes according to established productivity goals while maintaining established quality goals.
- Takes initiative to check and question unusual situations with management in accordance with established guidelines.
- Notifies the supervisor of trends that will impact internal and external customers.
- Work on ad-hoc projects as requested.
Education
- BA/BS Degree in a Business-related field or equivalent experience preferred.
Experience
- 2-3 years' experience in healthcare.
Knowledge, Skills, Abilities
- Ability to work and coordinate enrollment process and analytics in Commercial Membership Operations.
- Acute knowledge of EDI & enrollment systems.
- Understanding of XML/ANSI 834/HIPAA X12 transactions would be beneficial but not required.
- Must possess the ability to interface with internal/external customer at various levels.
- Willingness to work in a fast-paced, challenging environment.
- Detailed oriented and organized, with exceptional prioritization skills.
- Ability to effectively communicate with others and willingness to be a team player.
- Familiarity with data processing and the ability to work with documented policies and procedures.
- Proficient in Microsoft Applications.
- Health Rules/Proof, One Hub, SNOW, SharePoint or any other system that logs productivity.
- Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.