Insurance Accounting Specialist

MINIMUM QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. Associates' Degree in finance, accounting or business related field

EXPERIENCE:

1. Two (2) years of accounting or finance related experience

CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.

1. Premium Billing - processes the monthly premium billing cycle for ASO PEPM fees and Medicare Advantage enrollees. Reconciles invoices and premium receipt reports to premium billing reports. Reconciles and applies payments received for premium invoices.

2. CRM Responsibilities - Research, resolve and communicate resolution to internal team as well as external vendors for any finance related customer relationship management (CRM) request(s).

3. Claims Funding - Communicates weekly claims funding totals for both capitated and non-capitated claims to ASO clients as part of the weekly claims settlement process.

4. Claims Settlement Analytics - Provides management with weekly claims settlement analytics and reports.

5. Manages vendor information for accuracy relating to address and banking information to ensure payments to vendors are received and/or processed in a timely fashion.

6. Compiles and processes accounts payable, maintains day to day payment cycle, and provides efficient customer service. Ensure all Medicare Advantage claims are settled and processed in a timely manner to avoid penalty.

7. Verify approval on all vendor payment requests.

8. Process payments to contracted providers for claims submitted to and processed by the Claims Operations department.

9. Resolves problems associated with vendor payables transactions.

10. Reconciles processed work by verifying entries and comparing system reports to balances.

11. Provides accurate and effective document preparation and records management relative to the Claims Payable function in accordance with records retention policies and procedures, and any federal regulations.

12. Maintain relationships will all areas of the organization to ensure effective, efficient, and accurate workflow processes as it relates to claims processing and customer service to both internal and external clients.

13. Protects organization's value by keeping information confidential. Adere to all HIPPA regulations.

14. Updates job knowledge by participating in educational opportunities.

15. Maintains historical records by imaging and filing documents.

PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Manual dexterity used in operating standard office equipment.

2. Prolonged periods of sitting.

3. May be required to walk to various areas throughout the department or medical complex. This may require use of elevators and/or stairs.

4. Occasionally lifts up to 15 lbs.

5. Must be able to use a computer, answer the telephone and use other office equipment (fax, copier, printer)

WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. The employee will be working in an office environment.

SKILLS AND ABILITIES:

1. Ability to work with computers

2. Flexible and detail oriented.

3. Organized and professional

Additional Job Description:

Scheduled Weekly Hours:

Shift:

Exempt/Non-Exempt:

Company:

Cost Center:

Address:

Equal Opportunity Employer

West Virginia University Health System and its subsidiaries (collectively "WVUHS") is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. WVUHS strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law. All WVUHS employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation, benefits, and termination of employment.