Premium Billing Financial Senior Analyst - Hybrid

Company: Fallon Health
Location: Worcester
Posted on: September 2, 2024

Job Description:

Overview:The Premium Billing Financial Senior Analyst will require working in the office Tuesdays, Wednesdays and Thursdays and Mondays and Fridays will work from home.About Fallon Health:Fallon Health is a company that cares. We prioritize our membersalwaysmaking sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, Fallon delivers equitable, high-quality coordinated care and is continually rated among the nations top health plans for member experience, service, and clinical quality. Today, guided by our mission of improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programsincluding Medicare, Medicaid, and PACE (Program of All-Inclusive Care for the Elderly) in the region. Learn more at fallonhealth.org or follow us on Facebook, Twitter and LinkedIn.Brief Summary of Purpose:Under the direction of the Manager, the Premium Billing Financial Analyst supports Fallon Healths mission, vision, and values by providing and maintaining timely and accurate premium billing information. Responsibilities include but are not limited to the overall understanding and operation of the Premium Billing department to ensure the accurate processing of bill runs, collections, adjustments, and reconciliations. Reconciliation of subsidy payments from members, CMS, State of MA, and State of NY. Processing of adjustments recorded from members accounts and discrepancy reporting and resolution. Serves as SME for testing of core system upgrades. Works with staff to review & enhance current workflows related to AR processing within the core system. Assists the department Director and Manager in maintaining newly created metrics to ensure timely and accurate maintenance of receivable balances.The Premium Financial Analyst will complete work accurately and timely to remain in compliance with DOI, CMS and EOHHS regulations. Appropriately escalates concerns when necessary and follows issues through to closure. Problems not clearly defined by written directives or instructions are reviewed with the Enrollment & Billing Operations Manager, or Enrollment & Billing Operations Director to determine course of action.The Premium Financial Analyst collaborates effectively with co-workers and other departments to ensure quality service to our internal and external customers. This includes maintaining a positive approach to issues and concerns as they arise and works to identify and recommend process improvements to the direct supervisor/manager. Responsible for ensuring the integrity of information being entered & maintained within the QNXT system. Must be able to analyze various situations and make independent decisions on best practices in the interest of the members and the health plan.Pre-requisites for success in this position include strong verbal & written communication skills including demonstrated excellence in telephone communication, strong organizational skills, and computer skills. Performs all functions necessary to maintain accurate subsidiary accounts receivable and ensure accuracy of premium bills. Reconciles employer group bills to group payment listings or direct pay member bills, and appropriately research. Reviews monthly Accounts Receivable Summary and Aged Trial Balance to identify problems with payments, etc. Works collaboratively with the leadership team to ensure completion of monthly and yearly subsidiary accounts receivable and premium billing reports.Handles confidential customer information. Knowledge of plan policies, protocols, and procedures. Requires ability to work in a fast-paced environment with multi-disciplined staff. Consistent follow through on issue resolution and strong multitasking abilities are essential along with taking accountability and understanding job functions can change based upon the business need. Initiates self-development via available company and industry educational opportunitiesThe Premium Billing Financial Analyst is responsible for enrollment and billing maintenance, adhering to daily, weekly, and monthly schedules and administrative related tasks.Responsibilities:Job Responsibilities:Maintains receivable balances & Learning/DevelopmentCoordinates the accurate and timely production of all Premium Bill runs with outside Vendor, Cathedral, and acts as backup to group billing when needed.Responsible for all Daily and Month End reporting; including but not limited to Accounts Receivable Summary, Aged Trial Balance, Credit, and balance forward reporting.Reviews accounts for refunds and adjustments, verifying for accuracy and compliance to established policies and procedures.Posts payment files received from State and Federal entities to members accountsPerforms reconciliation of accounts receivable accounts to ensuring accuracy and integrity of premiums billed as well as appropriate application of premium payments. This includes preparation of outstanding balance reporting to Enrollment & Billing Operations Director, Product line owners and VP of Finance.Enters and maintains premium rates in the core systemWorks to ensure proper rating categories are reflected in core systemWorks proactively to ensure premium billing records are kept current and are accurate. Ensures goals and turnaround standards are being met or exceeded based on corporate and departmental metricsDistributes, on a daily basis, ACH, CC, wire, returns, and payment batches for posting by staff.Receives and processes daily Lockbox and Invoice Cloud payment file.AR liason with Accounting and IT for questions/enhancmentsEvaluates enhancement of Premium Billing operations by studying functionality of systems, procedure documents and overall productivity.Works with Operations Support Services on the creation of monthly metric reports utilizing the data from premium billing functionsServes as SME with core system upgradesWorks with management team for creation of updated workflows related to accounts receivable processingWorks with QA on the creation/maintainance of desk top procedures and P & PsAssists Management team on audit responses and/or site visitsParticipates in departmental and company-wide process improvement projects, training, testing and team meetings as assigned.Works department returned mailMaintains up-to-date productivity records on a daily and monthly basis for corporate and departmental dashboards.Provides detailed analyses and explanations of all transactions to Enrollment and Billing Director/Manager and COO as requestedPerforms other duties as they are assigned to meet department performance goals and to respond to changing priorities including administrative related tasks.Additional duties may be assigned or requested by the Director or ManagerQualifications:Education:Bachelors Degree in Accounting or Business, or equivalent experience.License/Certifications:N/AExperience:Experience: 5 plus years experience in an office environment, preferably in health care and/or managed care systemStrong Financial background related to Premium BillingFlexibility in a fast-paced environment.Excellent Organizational skills/time managementStrong focus on quality & performance resultsSystems knowledge including but not limited to MS Excel, MS Word, MS Access.Ability to effectively communicate, both written and verbal.Excellent telephone manner.Problem-solving capabilities.Builds Relationships/contributes to team performanceRespond to all audit requests timelyAdhere to all DOI, State, and Federal guidelinesFallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.#P01by Jobble

Keywords: Fallon Health, Worcester , Premium Billing Financial Senior Analyst - Hybrid, Accounting, Auditing , Worcester, Massachusetts