Premium Billing Representative

Job Number: 4900

Workplace Type: Office Full-Time

Position Title: Premium Billing Representative

External Description:

Alignment Healthcare is seeking a premium billing representative to manage the premium billing activities for the enrollment department. Premium billing includes producing and sending monthly statements, reviewing payments made, reconciling and collecting outstanding accounts. This position serves as the first point of contact for questions from individuals regarding premium invoices. In addition, the PBA is responsible for maintaining the Centers of Medicare and Medicaid Services (CMS) timeliness, quality standards, policies and procedures.

As a premium billing representative, you will assist with establishing and maintaining interdepartmental workflow, developing and implementing policies to improve the quality, timeliness and accuracy of information, throughout the organization and for providing reporting and data validation services.

Essential Duties and Responsibilities

(May include, but are not limited to)

• Reconcile premium payments from members.
• Identify and resolve premium payment discrepancies
• Answer questions from individuals and third-party vendor
• Prepare and submit monthly premium invoices to individuals either electronically or by paper
• Follows and report status of delinquent accounts
• Analyze data as it pertains to member premiums
• Maintain all information regarding membership premiums in the membership system
• Process member premium billing for Alignment Heathcare product lines
• Maintain required tracking / reporting
• Define and produce process reports for the operation of the department including but not limited to the complete processing of change requests, result reporting and overall departmental performance reporting
• Manage record and electronic data archive and storage and quality control for the retention of these key documents / records
• Perform all other duties as requested by management
• Understands and abides by all departmental policies and procedures.

Supervisory Responsibilities

There are no supervisory responsibilities. 

Minimum Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  The requirements listed below are representative of the knowledge, skill, and/or ability required.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Education: High school diploma required. Bachelor’s degree (preferred)
• Minimum 1-year experience in a health maintenance organization (HMO)
• Experience with HMO or Medicare Advantage Prescription Drug Plan (MA-PD) preferred
• Minimum 2 years’ experience with financial analysis, accounts receivable, and / or premium billing preferred
• Experience with CMS requirements for premium billing
• Proficiency with Microsoft Office Suite of products (Word, Excel, Access, etc.)
• Skills and Abilities
  • Language Skills: Able to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals.  Ability to write routine reports and correspondence.  Able to speak effectively before groups of customers or employees of the organization.
  • Mathematical Skills: Able to add and subtract two digit numbers and to multiply and divide with 10’s and 100’s.  Ability to perform these operations using units of American money and weight measurement, volume, and distance.
  • Reasoning Skills: Able to apply common sense understanding to carry out detailed but uninvolved written or oral instructions.  Ability to deal with problems involving a few concrete variables in standardized situations.
  • Computer Skills: Basic skills required.
• Other Skills and Abilities:
  • Strong written and verbal communication skills
  • Strong interpersonal skills.
  • Strong organizational skills.
  • Possess excellent customer services skills.
  • Possess ability to prioritize
  • Possess excellent problem-solving skills
  • Able to reason and carry out instructions.
  • Able to complete tasks in a timely manner
  • Able to type minimum 45 words per minute.
  • Proficient data entry skills
  • Able to file systematically.
  • Self-motivated
  • Self-starter and able to work independently

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear.
2. The employee is frequently required to reach with hands and arms.
3. The employee is occasionally required to stand; walk; climb or balance and stoop, kneel, crouch, or crawl.
4. The employee must occasionally lift and / or move up to 30 pounds.
5. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.

Working Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

City: Orange

State: California

Location City: Orange

Location State: California

Community / Marketing Title: Premium Billing Representative

Company Profile:

Alignment Health is revolutionizing health care for seniors by leveraging our world-class technology platform, innovative care delivery models, deep physician partnerships and our serving heart culture! From member experience professionals and clinicians, to data scientists and operations leaders, we have built a talented and passionate team that is deeply committed to our mission of transforming health care for the seniors we serve. Ready to join us?

At Alignment Alignment, delivering exceptional care to seniors starts with ensuring an exceptional experience for our over 1,300 employees. At the center of our employee experience is a culture where employees at all levels and across all teams are encouraged to share their unique ideas and perspectives. After all, when you can bring your authentic self to work, whether that’s in a clinical setting, our corporate office or a home office, creativity and innovation flourish! Another important part of the Alignment culture is a belief in continuous learning and growth. As a result, in this fast-growing company, you will find ample support to grow your skills and your career – with us.

EEO Employer Verbiage:

 Please note: All clinical positions are contingent upon successful engagement with Alignment Health’s COVID-19 Vaccination program (fully vaccinated with documented proof or approved exception/deferral).

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email [email protected].