Gateway Specialist
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.
IBX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.
Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.
Inclusion and Belonging
At IBX, everyone can feel valued, supported, and comfortable to be themselves, and all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. Celebrating and embracing diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.
About Our Company
Serving more than 8 million people nationwide, including 2.5 million in southeastern Pennsylvania, Independence Health Group — together with its subsidiaries — is the leading health insurance organization in the Philadelphia region. Our mission to build healthier lives for you, your family, and your employees shapes our actions and decisions every day.
At Independence, we see each of our members as an individual, with unique needs and concerns. We’re dedicated to harnessing the very latest ideas and technologies to deliver access to care that meets those needs and surpasses your expectations. For more information about Independence access our website at www.ibx.com. We’re revolutionizing health care, and our focus is on you!
Equal Employment Opportunity
IBX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.
Agency Disclaimer
All resumes submitted directly to an Independence Blue Cross employee from a vendor via email, the Internet or in any other form without a valid written search agreement in place for this position from the Independence Blue Cross Family of Companies Human Resources Department will be deemed the sole property of Independence Blue Cross and the Independence Blue Cross Family of Companies. Please note that no fee will be paid in the event the candidate is hired by Independence Blue Cross or the Independence Blue Cross Family of Companies as a result of the referral or through means other than our established process.