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.
Acerca de Cognizant
Cognizant (Nasdaq: CTSH) es un creador de soluciones de IA y proveedor de servicios tecnológicos que conecta la inversión en IA con el valor empresarial mediante el desarrollo de soluciones de IA full‑stack para sus clientes. Su profundo conocimiento de la industria, junto con su experiencia en procesos e ingeniería, permite incorporar el contexto único de cada organización en sistemas tecnológicos que amplifican el potencial humano, generan resultados tangibles y mantienen a las empresas a la vanguardia en un entorno en constante cambio. Más información en cognizant.ai o @cognizant.
Información adicional de empleo
La información de compensación es precisa a la fecha de esta publicación. Cognizant se reserva el derecho de modificar esta información en cualquier momento, sujeto a la legislación aplicable.
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