Resp & Qualifications
Compiles, validates and supports financial data for upload to Oracle to ensure accuracy of the TPA’s financial statements. Establishes and maintains comprehensive Excel spreadsheets for cash application and reconciliation to daily bank statements to ensure the bank and CFA systems are in sync. Audits ancillary vendor payments to ensure accuracy of remittances. This involves ensuring that the rates are accurate, mapping of fields correspond to CFA systems, customizations are linked, and there aren’t any ‘fallouts’ in the C&R files.
Establishes and maintains relationships with Points of Contact (POC) at account and vendor levels. Needs to have a solid and in depth understanding of the client product requirements and be able to effectively establish and maintain rate requirements needed to implement accounts. Responsible for troubleshooting LuminX admin rate discrepancies and vendors accounts to ensure all rates/payments are clearly communicated and supported.
Responsible for monitoring and tracking manual billing data as well as enrollment system updates. Must be able to prioritize work and provide direct customer support for billing issues and various enrollment needs. Provides regular progress reports for internal and external stakeholders when appropriate. Creates AdHoc queries and reports by request. Supports external audit requests when required.
Troubleshoots user system issues. Works with vendors, account management and technical resources to track and correct identified issues in a timely manner. Develops solutions and recommends workarounds to solve low to mid-complexity technical and/or business issues. Ensures that appropriate controls exist, are efficient and accurate and in compliance with TPA standards. Works with internal and external stakeholders to track and resolve issues as required.
Conducts user acceptance testing for vendor change requests and for scheduled system releases to identify defects and ensure proper resolution prior to sign off for production. Ability to create test billing data for User Acceptance Validation.
Special projects as assigned.
Work independently with minimal supervision
Excellent customer service skills
Knowledgeable about accepted accounting practices
Must have excellent computer skills
Must be detailed oriented and highly organized
Must be an efficient multi-tasker and be able to prioritize multiple deliverables
Must have superior analytical skills
No travel is expected for this position.
Required Education and Experience:
Bachelor’s Degree in Accounting, Finance or other math related field.
Minimum 4-5 years of accounting, business, or finance experience.
Other requirements (certifications and so forth) TPA experience.
Note that these requirements are representative, but not all-inclusive, of the knowledge, skill, and ability required performing this job.
LuminX and/or Oracle experience. Insurance experience. TPA experience.
Department: Finance & Funding
Equal Employment Opportunity
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Hire Range Disclaimer
Actual salary will be based on relevant job experience and work history.
Where To Apply
Please visit our website to apply: www.carefirst.com/careers
Please apply before: 7/31/18
Federal Disc/Physical Demand
Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
The physical demands described here are representative of those that must be met by an employee to perform the essential duties and responsibilities of the position successfully. Requirements may be modified to accommodate individuals with disabilities.
The employee is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The employee must frequently talk and hear. Weights of up to 25 pounds are occasionally lifted.
Sponsorship in US
Must be eligible to work in the U.S. without Sponsorship