Administrative Support Specialist

Imagine360 is seeking an Admin Support Specialist to join the team! The Admin Support Specialist is responsible for supporting regulatory eligibility reporting, data administration, and operational audit activities across multiple claims systems within the organization. This role prepares and submits state and federal reporting requirements, including vaccine assessments, healthcare surcharges, and CMS Section 111 reporting, while researching and resolving reporting discrepancies. The position also supports EDI/834 file audits, new business implementation activities, and data quality reviews to ensure accuracy and compliance. The ideal candidate possesses strong analytical skills, advanced Excel expertise, exceptional attention to detail, and the ability to effectively collaborate with internal and external stakeholders while maintaining HIPAA and regulatory compliance standards

Position Location: 100% remote

Responsibilities include but are not limited to:

Ownership of state and federal required eligibility reporting.

• State Vaccine Reporting
  • File and report all required state vaccines assessments timely (monthly, quarterly, annually) for all claims systems.
  • Correspond with finance and client banking on state assessments fee payments and client reimbursement.
  • Track and maintain government reporting status for all applicable states.
• NY/MA surcharges
  • File monthly NY and MA surcharges with states for all applicable claims systems.
  • Correspond with claims support and client banking on surcharge payments and client reimbursement.
  • Track and maintain government reporting status.
• CMS 111 reporting
  • Create, File and submit quarterly CMS section 111 reporting following system specifications and SOPs accurately and timely on a quarterly basis, per system.
  • Process CMS response files.
  • Review CMS errors and own the correction process.
  • Partner with configuration, plan build, eligibility and others to resolve CMS errors before next filing.
• Support EDI/834 implementation and audit.
  • Support EDI specialist with auditing new and changing 834 files before releasing to production.
• Support New Business implementation and audit.
  • Support New Business specialist with common census file creation, SEI creation, and audit before releasing to production.
  • Communicate with internal stakeholders, and externally with regulatory bodies, vendors, clients and/or brokers to resolve file concerns and issues.
• Participate in required training and meetings, one on one coaching sessions, and team huddles.
• Perform other duties and projects assigned.
• Perform all tasks in accordance with HIPAA guidelines.

Required Experience/Education:

• 2 years of reporting, operations, back or front office and/or customer service experience required, or equivalent combination of education and experience.
• Health Care Administration background a plus!
• Prior CMS Experience a plus!
• High School Diploma or GED required.

Skills and Abilities:

• Strong PC skills, prior experience with MS Office required.
  • Advanced MS Office experience specific to Excel and Lists.
  • Moderate MS Office experience specific to Word, PowerPoint, Visio, and CoPilot.
• Ability to interpret and manipulate large amounts of data, making sense of transactions.
• Ability to manage time, ensuring all requirements are met by company standards.
• High level of accuracy and attention to detail.
• Strong verbal and written communication skills, comfortability in communicating at various levels with internal and external stakeholders.
• Team player able to collaborate with other departments.

What can Imagine360 offer you?

• Multiple Health plan options
• Company paid employee premiums for disability and life insurance
• Parental Leave Policy
• 20 days PTO to start / 10 Paid Holidays
• Tuition reimbursement
• 401k Company contribution
• Company paid Short & Long term Disability plus Life Insurance
• Professional development initiatives / continuous learning opportunities
• Opportunities to participate in and support the company's diversity and inclusion initiatives

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Imagine360 is a health plan solution company that combines 50+ years of self-funding healthcare expertise. Over the years, we've helped thousands of employers save billions on healthcare. Our breakthrough total health plan solution is fixing today's one-size-fits-none PPO insurance problems with powerful, customized, member-focused solutions.

Imagine360 is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.

**RECRUITMENT AGENCIES PLEASE NOTE: Imagine360 will only accept applications from agencies/business partners that have been invited to work on a specific role. Candidate Resumes/CV's submitted without permission or directly to Hiring Managers will be considered unsolicited and no fee will be payable. Thank you for your cooperation**