Job Description

SummaCare - 1200 E Market St, Akron, OH

Full-Time / 40 Hours / Days

Hybrid or Remote

As a regional, provider-owned health plan, SummaCare values the relationship between the members and their doctors. SummaCare is a part of Summa Health, an integrated healthcare delivery system that includes Summa Health System hospitals, its community-based health centers, dedicated clinicians and SummaCare. Based in Akron, Ohio, SummaCare provides Medicare Advantage, individual and family and commercial insurance plans. SummaCare has one of the highest rated Medicare Advantage plans in the state of Ohio, with a 4.5 out of 5-Star rating for 2025 by the Centers for Medicare and Medicaid Services (CMS). Known for its excellent customer service and personalized attention to members, SummaCare is committed to building lasting relationships. Employees can expect competitive pay and benefits.

Summary

:


Coordinates daily operations of the Eligibility & Billing technical team, including EDI processing of enrollment and payment transactions and reconciliation of enrollment and payment status between SummaCare and its clients, vendors and regulatory agencies. Performs auditing and monitoring activities as assigned by Manager. Escalates at-risk assignments to management as needed to ensure all transactions are processed according to established standard for timeliness and accuracy. Assists management with providing support for delegation of work, training, and resolution of issues. Provides daily support to technical team to cover workloads.

Formal Education Required:

a. Associates degree or equivalent combination of education and/or experience.

Experience & Training Required

:


a. Three (3) years' experience in technical/analytical functions in healthcare or finance environment.




Other Skills, Competencies and Qualifications:


a. Foster a positive and teamwork oriented environment.


b. Demonstrate proficiency in eligibility, billing, and accounts receivable functions.


c. Demonstrate proficiency using Windows, Outlook, Web Browsers and other computer based information management tools as required. (Word, MS Excel and/or Access at intermediate level)


d. Ability to communicate in a professional manner to a wide variety of audiences, including Senior Leadership. This includes presentations, correspondence, instructional material, reports, policies and procedures, legal and or technical documents. Excellent proofreading skills


e. Strong analytical skills to review regulatory guidance and create action plans for implementation of new and changing rules. Ability to review data from a variety of sources in order to make recommendations/conclusions based on the outcomes.


f. Excellent attention to detail and strong trouble shooting skills.


g. Organize and manage time to accurately complete tasks within designated time frames in fast-paced environment.


h. Maintain current knowledge of and comply with regulatory and company policies & procedures.


i. Maintain confidentiality of member health and business information.


j. Flexible: ability to adjust work hours to meet business demands.




Level of Physical Demands:


a. Light: Exerts up to 20 pounds of force occasionally and/or up to ten pounds of force frequently, and/or a negligible amount of force continuously.

Equal Opportunity Employer/Veterans/Disabled



$28.10/hr - $42.15/hr
The salary range on this job posting/advertising is base salary exclusive of any bonuses or differentials. Many factors, such as years of relevant experience and geographical location are considered when determining the starting rate of pay. We believe in the importance of pay equity and consider internal equity of our current team members when determining offers. Please keep in mind that the range that is listed is the full base salary range. Hiring at the maximum of the range would not be typical.


Summa Health offers a competitive and comprehensive benefits program to include medical, dental, vision, life, paid time off as well as many other benefits.


Basic Life and Accidental Death & Dismemberment (AD&D) Supplemental Life and AD&D Dependent Life Insurance Short-Term and Long-Term Disability Accident Insurance, Hospital Indemnity, and Critical Illness Retirement Savings Plan Flexible Spending Accounts - Healthcare and Dependent Care Employee Assistance Program (EAP) Identity Theft Protection Pet Insurance Education Assistance * Daily Pay