Billing Specialist-TPA (Remote-Ohio)

This is a fully remote opportunity; Ohio candidates preferred.

Reconciles prescription invoices and claim files for client billing and communicates billing totals to operations. Researches reconciliation differences to their conclusion. Interfaces with both internal and external customers as needed regarding Rx billing issues.

Responsibilities

• Processes weekly, bi-weekly, and monthly prescription invoices and claims files received from various Pharmacy Benefit Managers (PBMs) for client billing including the reconciliation of the PBM invoices to the claims detail. Researches and resolves any identified reconciliation discrepancies. Prepares daily billing spreadsheet for Operations. Communicates with the Operations and Service teams as needed.
• Acts as a backup for accounting operational functions such as weekly claims billing and receipts, compiling data sheets requested by groups and refund processing.
• Performs other duties as assigned.

Qualifications

• Associate degree in business, accounting, or related field or equivalent combination of experience, training, and education.
• 2 years of recent accounting, billing and related experience.
• Basic working knowledge of Generally Accepted Accounting Principles (GAAP) accounting theory and practice.
• Intermediate MS Office Skills.

Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That's why we offer an exceptional package that includes:

A Great Place to Work:

• Top Workplace in Northeast Ohio. Year after year we've received this recognition!
• On-site wellness center at most locations. Enjoy personal trainers, towel service, locker room, weight room, elliptical machines, and a variety of classes!
• On-site cafeteria serving hot breakfast and lunch, at most locations. Choices ranging from salad bar, made to order, hot and cold sandwiches, or a variety of entrees cooked fresh daily. Convenience store at most locations
• Employee discount program. Discounts at many places in and around town, just for being a Medical Mutual team member
• Business Casual attire

Excellent Benefits and Compensation:

• Competitive compensation plans
• Employee bonus program
• 401(k) with company match and an additional company contribution
• Excellent medical, dental, vision, and disability insurance

An Investment in You:

• Career development programs and classes
• Mentoring and coaching to help you advance
• Education reimbursement up to $5K per year

About Medical Mutual:

We strive to create peace of mind. Our customers can trust us to do things right and to help them get value from their health plan. We're the largest health insurer in Ohio and for over 85 years, we've been serving our members and the Ohio communities where they live and work. Medical Mutual is a Top Place to Work in Northeast Ohio with exceptional career opportunities that offer challenge, growth and a great work/life balance. We want talented, innovative, and driven people to help us continue to be the best health insurance choice of Ohioans and help make Ohio the best it can be! Our headquarter building is located in the heart of downtown Cleveland and we have multiple offices throughout the state. Join us at one near you!

At Medical Mutual and its family of companies we celebrate differences and are mutually invested in our employees and our community. We are proud to be an Equal Employment Opportunity and Affirmative Action Employer. Qualified applicants will receive consideration for employment regardless of race, color, religion, sex, sexual orientation, gender perception or identity, national origin, age, marital status, veteran status, or disability status.

We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.