Quality Control Business Analyst

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🔥 4 minutes ago

⚔️ Virginia – Remote

⚔️ Virginia – Remote

💵 $45k - $72k / year

⏰ Full Time

🟢 Junior

🧐 Business Analyst

🚫👨‍🎓 No degree required

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PacificSource Health Plans

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1933

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

PacificSource Health Plans is a healthcare provider that offers a range of health insurance solutions, including plans for individuals, families, and employers. Their offerings include Medicare and Medicaid plans, dental coverage, and administrative services for small and large groups. Committed to member care, PacificSource emphasizes customer service and provides various resources for health management, including mental health support and wellness programs.

📋 Description

• Audit and report on the accuracy of enrollment and billing transactions and processes across Operations. • Collaborate with IT, Facets Business Support, Finance, and external vendors to support configuration updates, system interfaces, and reporting. • Ensure compliance with Federal and State Exchange guidelines, and assist with reconciliation of accounts receivable, eligibility, and billing. • Recommend and implement process improvements to enhance operational efficiency and data integrity. • Conduct audits of operational job functions; document findings; maintain audit records and prepare reports for management. • Perform monthly accounts receivable reconciliations across all lines of business; ensure timely reporting to Finance. • Reconcile Exchange enrollment and billing reports; resolve discrepancies in collaboration with CMS and State Exchanges. • Support Membership Representatives in resolving group account discrepancies, particularly when payments differ from billed amounts. • Partner with reporting teams to develop, test, and maintain reports; assess impacts of configuration changes and request ad hoc reports as needed. • Assist IT and Facets Business Support in testing and validating configuration and interface changes, including 834 files and other member data exchanges. • Identify and resolve data issues in member files; monitor new processes for efficiency and effectiveness. • Convert student health insurance rates to daily rates for system entry; validate accuracy with Underwriting. • Prepare and reconcile daily lockbox spreadsheets and cash receipts; investigate and resolve discrepancies with Finance and third-party vendors. • Monitor pending payment accounts; maintain tracking tools such as SharePoint and assist with TPA spreadsheet setup and macro updates. • Validate ACH Debit files prior to bank submission. • Resolve enrollment and eligibility issues to support accurate claims processing. • Collaborate with MarCom and IT to create and troubleshoot member communication letters. • Develop, update, and maintain departmental procedures and documentation. • Contribute to process improvement initiatives to enhance operational efficiency and data integrity. • Review the Exchange enrollment and billing reports (daily, weekly, monthly); facilitate reconciliation to comply with the Federal and State Exchange guidelines.

🎯 Requirements

• Minimum of 1 year of Enrollment and Billing experience and/or business analysis experience required. • Advanced level experience using Excel, creating spreadsheets, using formulas, pivot tables and performing data comparisons required. • Strong research and troubleshooting experience are required. • Accounting experience is preferred. • High school diploma or equivalent required. • Associate’s degree preferred. • Ability to gain understanding of PacificSource products, plan designs, group contracts, eligibility guidelines, billing functions, accounts receivable, and health insurance terminology. • Ability to gain knowledge of the Eligibility and Billing Analyst, and Membership Representative I & II positions. • Ability to work independently as well as within a team. • Strong keyboarding and 10-key skills required.

🏖️ Benefits

• Flexible telecommute policy • medical, vision, and dental insurance • incentive program • paid time off and holidays • 401(k) plan • volunteer opportunities • tuition reimbursement and training • life insurance • options such as a flexible spending account