What are the responsibilities and job description for the Individual Eligibility and Billing Analyst position at PacificSource Health Plans?
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PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths.
Provide support to the Individual Billing and Service team, Customer Service, Information Technology, and Sales departments. Audit, evaluate, and report the accuracy of the Individual team's processes and make recommendations for process improvement. Work with IT, Facets Business Support, and external vendors on configuration changes, interfaces, and reports. Ability to perform all functions of the Individual Billing and Service positions.
Essential Responsibilities:
- Perform audits of job functions as determined necessary by Manager. Document outcomes of audits and prepare reports for Manager and Team Leaders. Create and maintain documentation of audit processes.
- Analyze and resolve eligibility and billing discrepancies, and identify training opportunities.
- Take a lead role in assisting Facets Business Support and IT teams with testing and validation of interface changes, defects, system upgrades, reports, and billing configuration. Work with outside vendors when interface is used to communicate member data, such as e-Health. Diagnose and resolve data issues on files and website content.
- Work with Actuarial team to review monthly rate audit, and make corrections as needed.
- Knowledge of data and functionality in PSE, OnBase, EMS, and Facets. Identify operational improvements that support department objectives.
- Participate in the Mentor Team, developing and presenting lessons as needed.
- Assist with the annual renewal process, reviewing NOC letters, member moves or discontinuance, and auditing records to identity and resolve discrepancies. Determine if new classes are needed and provide data to Group Processing Specialists for data entry.
- Attend conference calls with CMS and state based exchange workgroups, including YHI and WAHBE.
- Create documentation for new processes as needed. Update existing documentation, and review documentation written by others within the department for accuracy. Analyze new processes to ensure efficiency and effectiveness.
- Verify residency of members on an as needed basis. Process rescissions following all legal requirements.
- Process billing & delinquency suspend requests. Monitor delinquency and suspend reports, ensuring compliance with legal notification requirements.
- Prepare documents for imaging and attach properties to documents in OnBase.
- Provide excellent internal and external customer service via email, phone, and fax.
- Monitor various other reporting.
Supporting Responsibilities:
- Meet department and company performance and attendance expectations.
- Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
- Provide back-up support as needed for Commercial Enrollment & Billing Department.
- Serve on various interoffice committees as required or needed.
- Perform other duties as assigned.
Work Experience: At least two years of closely related insurance experience and/or accounting experience required.
Education, Certificates, Licenses: High school diploma or equivalent required.
Knowledge: Understanding of PacificSource products, plan designs, Individual contracts, eligibility guidelines, billing functions, accounts receivable, and health insurance terminology. Requires ability to perform all functions of the Individual Billing Specialist and Individual Service Representative positions. Ability to work independently as well as within a team. Require intermediate level experience using Excel, creating spreadsheets, using formulas, pivot tables and performing data comparisons. Keyboarding and 10-key skills required.
Competencies:
Building Customer Loyalty
Building Strategic Work Relationships
Contributing to Team Success
Planning and Organizing
Continuous Improvement
Adaptability
Building Trust
Work Standards
Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 5% of the time.
Skills:
Accountability, Collaboration, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork
Our Values
We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:
- We are committed to doing the right thing.
- We are one team working toward a common goal.
- We are each responsible for customer service.
- We practice open communication at all levels of the company to foster individual, team and company growth.
- We actively participate in efforts to improve our many communities-internally and externally.
- We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
- We encourage creativity, innovation, and the pursuit of excellence.
Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.
Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.