[Hiring] Quality Control Business Analyst @PacificSource Health Plans

Role Description

Looking for a way to make an impact and help people? Join PacificSource and help our members access quality, affordable care!

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.

Essential Responsibilities:

• 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.

Supporting Responsibilities:

• Develop and maintain positive working relationships with Individual Services staff, other employees, external partners, customers, and vendors based on open communication, interacting in a supportive capacity, and treating all with respect.
• Participate in committees and/or projects as assigned.
• Provide assistance as needed for the Individual Services.
• 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.
• Perform other duties as assigned.

Qualifications

• 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.

Requirements

• 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

• Compensation Disclaimer: The wage range provided reflects the full range for this position. The maximum amount listed represents the highest possible salary for the role and should not be interpreted as a typical starting wage. Actual compensation will be determined based on factors such as qualifications, experience, education, and internal equity.
• Base Range: $44,982.98 - $71,972.77

Company Description

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.