Job Summary
Serve as a senior specialist in enrollment and billing within a hybrid work model applying deep knowledge of HIPAA compliance benefits open enrollment processes and payer and provider operations. Ensure accurate timely and compliant member enrollment and billing activities in a night shift environment supporting a seamless experience for health plan members and partners.
Responsibilities
- Coordinate complex member enrollment and billing activities across multiple payer and provider systems to ensure timely and accurate processing of all transactions in a night shift setting.
- Ensure strict adherence to HIPAA regulations when handling enrollment data and billing records so that all protected health information remains secure and fully compliant.
- Analyze benefits open enrollment files and eligibility feeds to validate member elections identify discrepancies and recommend corrective actions that prevent downstream billing issues.
- Design and refine enrollment and billing workflows that reduce manual effort minimize defects and accelerate cycle time while maintaining high standards of quality and compliance.
- Collaborate with payer and provider stakeholders to clarify benefits rules eligibility criteria and coverage configurations so that enrollment data aligns with contractual obligations.
- Perform root cause analysis on recurring enrollment and billing defects and develop sustainable remediation plans that reduce rework and improve customer satisfaction.
- Create and maintain detailed documentation for enrollment rules billing logic file formats and exception handling so that project teams and operations staff can execute processes consistently.
- Coordinate with technology teams to translate business requirements for HIPAA compliant enrollment and billing solutions into clear functional specifications and acceptance criteria.
- Validate inbound and outbound enrollment and billing files using test cases that reflect real world payer and provider scenarios to confirm system reliability and data integrity.
- Provide subject matter guidance during production incidents related to enrollment and billing by investigating data flows and recommending safe mitigation steps.
- Monitor key performance indicators for enrollment accuracy billing timeliness and error rates and propose data driven improvements that align with organizational objectives.
- Guide junior analysts by sharing domain insights on payer and provider operations explaining complex benefit structures and demonstrating best practices in enrollment processing.
- Engage with business partners to explain the impact of benefit design changes on enrollment and billing timelines so that operational expectations are realistic and achievable.
Qualifications
- Demonstrate extensive experience working with HIPAA standards in healthcare enrollment and billing contexts including handling electronic data with a focus on privacy and security.
- Exhibit strong practical expertise in benefits open enrollment processes including eligibility determination coverage elections and downstream billing implications.
- Bring proven domain experience across both payer and provider environments including familiarity with health plan structures provider networks and claim lifecycle touchpoints.
- Apply advanced analytical skills to interpret complex enrollment and billing data sets using tools such as spreadsheets or reporting platforms to identify and resolve anomalies.
- Use excellent verbal and written communication skills to collaborate with cross functional stakeholders in a hybrid work model and clearly articulate technical and business concepts.
- Manage work independently during night shifts prioritizing tasks effectively and maintaining accuracy and focus without the need for constant oversight.
- Leverage prior experience of eight to nine years in healthcare enrollment billing or related operations to handle complex cases and guide peers in resolving challenging scenarios.
コグニザントについて
コグニザント（NASDAQ: CTSH）は、AI Builderおよびテクノロジーサービスプロバイダーとして、お客様にフルスタックのAIソリューションを構築することで、AI投資と企業価値を結ぶ架け橋となっています。業界、ビジネスプロセス、エンジニアリングに関する当社の深い専門知識を活かし、組織固有のビジネス環境をテクノロジー・システムに組み込みます。これにより、人間の可能性を最大限に引き出し、確かな成果を実現するとともに、急速に変化する世界においてグローバル企業が常に一歩先を行くための支援を行っています。 詳細については、cognizant.ai をご覧ください。
雇用に関する追加情報
本募集に記載されている報酬情報は、掲載日時点で正確なものです。Cognizantは、適用される法令に従い、いつでも本情報を変更する権利を留保します。
応募者は、対面またはビデオ会議による面接への参加を求められる場合があります。また、各面接の際に、現在有効な州政府または政府発行の身分証明書の提示を求められる場合があります。
Cognizantは機会均等雇用主です。応募および選考において、人種、肌の色、性別、宗教、信条、性的指向、性自認、国籍、障がい、遺伝情報、妊娠、退役軍人の地位、その他連邦法・州法・地方自治体の法律により保護されるいかなる特性に基づく差別も行いません。
