Revenue Specialist
Tufts Health Plan, Canton, MA, United States
Revenue Specialist
The Revenue Specialist develops and refines member eligibility and payment records. This role ensures the accuracy of the beneficiary files and data submission. The incumbent learns and understands department process interdependencies, contributes to process enhancement opportunities, and supports departmental objectives.
Key Responsibilities/Duties what you will be doing (top five):
Expands knowledge of the monthly payments received by CMS
Updates daily/monthly records received from CMS in all systems accordingly to match each other and to match CMS..
Reviews/researches data rejects
Adjusts member records and set sequences in Market Prominence (MP), Diamond, and HealthRules Payor (HRP) Special Status Beneficiaries
Works MSP (Medicare Secondary Payer) records, ensuring letters are sent to members timely, that incoming mail is completed quickly while updating in CMS system the responses from members. Work with Claims department to ensure updates affecting a member's claims are completed timely and accurately.
Other duties as assigned
Qualifications what you need to perform the job.
Education, Certification and Licensure
Required: Associate degree
Preferred: Some undergraduate college courses preferred.
Experience
Required: 1-2 years related business experience
Preferred:
Skill Requirements
Significant MS Office skills, with focus on Excel and Access at intermediate/advanced level.
Solid communication skills (effective verbal and written skills).
Strong organizational and time management skills.
Financial background a plus
Working Conditions and Additional Requirements (include special requirements, e.g., lifting, travel):
Must be able to work under normal office conditions and work from home as required.
Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations.
May be required to work additional hours beyond standard work schedule.
Salary Range
$21.00 -$31.51
Compensation & Total Rewards Overview
The annual base salary range provided for this position represents a range of salaries for this role and similar roles across the organization. The actual salary for this position will be determined by several factors, including the scope and complexity of the role; the skills, education, training, credentials, and experience of the candidate; as well as internal equity. As part of our comprehensive total rewards program, colleagues are also eligible for variable pay. Eligibility for any bonus, commission, benefits, or any other form of compensation and benefits remains in the Company's sole discretion and may be modified at the Company's sole discretion, consistent with the law.
Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes:
Medical, dental and vision coverage
Retirement plans
Paid time off
Employer-paid life and disability insurance with additional buy-up coverage options
Tuition program
Well-being benefits
Full suite of benefits to support career development, individual & family health, and financial health
We welcome all All applicants are welcome and will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.
Scam Alert : Point32Health has recently become aware of job posting scams where unauthorized individuals posing as Point32Health recruiters have placed job advertisements and reached out to potential candidates. These advertisements or individuals may ask the applicant to make a payment. Point32Health would never ask an applicant to make a payment related to a job application or job offer, or to pay for workplace equipment. If you have any concerns about the legitimacy of a job posting or recruiting contact, you may contact TA_operations@point32health.org
The Revenue Specialist develops and refines member eligibility and payment records. This role ensures the accuracy of the beneficiary files and data submission. The incumbent learns and understands department process interdependencies, contributes to process enhancement opportunities, and supports departmental objectives.
Key Responsibilities/Duties what you will be doing (top five):
Expands knowledge of the monthly payments received by CMS
Updates daily/monthly records received from CMS in all systems accordingly to match each other and to match CMS..
Reviews/researches data rejects
Adjusts member records and set sequences in Market Prominence (MP), Diamond, and HealthRules Payor (HRP) Special Status Beneficiaries
Works MSP (Medicare Secondary Payer) records, ensuring letters are sent to members timely, that incoming mail is completed quickly while updating in CMS system the responses from members. Work with Claims department to ensure updates affecting a member's claims are completed timely and accurately.
Other duties as assigned
Qualifications what you need to perform the job.
Education, Certification and Licensure
Required: Associate degree
Preferred: Some undergraduate college courses preferred.
Experience
Required: 1-2 years related business experience
Preferred:
Skill Requirements
Significant MS Office skills, with focus on Excel and Access at intermediate/advanced level.
Solid communication skills (effective verbal and written skills).
Strong organizational and time management skills.
Financial background a plus
Working Conditions and Additional Requirements (include special requirements, e.g., lifting, travel):
Must be able to work under normal office conditions and work from home as required.
Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations.
May be required to work additional hours beyond standard work schedule.
Salary Range
$21.00 -$31.51
Compensation & Total Rewards Overview
The annual base salary range provided for this position represents a range of salaries for this role and similar roles across the organization. The actual salary for this position will be determined by several factors, including the scope and complexity of the role; the skills, education, training, credentials, and experience of the candidate; as well as internal equity. As part of our comprehensive total rewards program, colleagues are also eligible for variable pay. Eligibility for any bonus, commission, benefits, or any other form of compensation and benefits remains in the Company's sole discretion and may be modified at the Company's sole discretion, consistent with the law.
Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes:
Medical, dental and vision coverage
Retirement plans
Paid time off
Employer-paid life and disability insurance with additional buy-up coverage options
Tuition program
Well-being benefits
Full suite of benefits to support career development, individual & family health, and financial health
We welcome all All applicants are welcome and will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.
Scam Alert : Point32Health has recently become aware of job posting scams where unauthorized individuals posing as Point32Health recruiters have placed job advertisements and reached out to potential candidates. These advertisements or individuals may ask the applicant to make a payment. Point32Health would never ask an applicant to make a payment related to a job application or job offer, or to pay for workplace equipment. If you have any concerns about the legitimacy of a job posting or recruiting contact, you may contact TA_operations@point32health.org