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.
À propos de Cognizant
Cognizant (NASDAQ : CTSH) est un AI Builder et une entreprise de services numériques (ESN) élaborant des solutions complètes d’IA maximisant les investissements pour des résultats concrets. Sa profonde expertise des métiers, des processus et des technologies lui permet d’intégrer dans les systèmes technologiques le contexte unique de chaque organisation de l’ingénierie à la production à l’échelle. Son objectif : améliorer l’efficacité des équipes, créer de la valeur et permettre aux grandes entreprises de rester performantes dans un monde qui évolue rapidement. Pour en savoir plus : cognizant.ai ou @cognizant.
Renseignments suppplémentaires sur l'emploi
Les informations sur la rémunération sont exactes à la date de publication. Cognizant se réserve le droit de modifier ces informations à tout moment, conformément aux lois applicables.
Les exigences linguistiques varient selon les postes, mais nous demandons à tous les candidats d’avoir une connaissance de base de l’anglais afin de faciliter les communications internes à l’échelle de l’entreprise. Pour les postes basés au Québec, une maîtrise de l’anglais est requise puisque vous fournirez des services et collaborerez avec des parties prenantes situées hors de la province, qui ne parlent pas nécessairement le français.
Cognizant est un employeur souscrivant au principe de l’égalité d’accès à l’emploi. Votre candidature et votre dossier ne seront pas examinés en fonction de la race, de la couleur, du sexe, de la religion, des croyances, de l'orientation sexuelle, de l'identité de genre, de l'origine nationale, du handicap, de l'information génétique, de la grossesse, du statut d'ancien combattant ou de toute autre caractéristique protégée telle que décrite par les lois fédérales, provinciales ou locales.
Si vous avez un handicap qui nécessite un aménagement raisonnable pour rechercher une offre d'emploi ou poser une candidature, envoyiez un courriel à [email protected] avec votre demande et vos coordonnées.
