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.
About Cognizant:
Cognizant (Nasdaq: CTSH) is an AI Builder and technology services provider, bridging the gap between AI investment and enterprise value by building full-stack AI solutions for our clients. Our deep industry, process and engineering expertise enables us to build an organization’s unique context into technology systems that amplify human potential, drive tangible outcomes and keep global enterprises ahead in a fast-changing world. See how at cognizant.ai or @cognizant.
Additional employment information
Compensation information is accurate as of the date of this posting. Cognizant reserves the right to modify this information at any time, subject to applicable law.
Language requirements vary depending on roles, but we ask that all candidates have basic English proficiency for company-wide communications purposes. For roles based in Quebec, professional English proficiency is required, as you’ll deliver services to and collaborate with stakeholders outside the province who may not speak French.
Cognizant is an equal opportunity employer. Your application and candidacy will not be considered based on race, color, sex, religion, creed, sexual orientation, gender identity, national origin, disability, genetic information, pregnancy, veteran status or any other characteristic protected by federal, provincial or local laws.
If you have a disability that requires reasonable accommodation to search for a job opening or submit an application, please email [email protected] with your request and contact information.
