Resp & Qualifications
ESSENTIAL DUTIES AND RESPONSIBILITIES under the direction of the Project Director, Financial Performance and InterPlan Analysis include, but are not limited to, the following:
Develops and maintains financial analysis of Home and Host interPlan reimbursements paid and received, including monitoring reports for comparing actuals to budget and trending year over year, by Plan, by account, by product and segment, or other breakouts as requested. Supports estimation of fees for prospects and new accounts; provides support for annual administrative expense budget and ongoing variance analysis. Identifies trends and/or issues and communicates to management and other areas as appropriate.
Responsible for knowledge of BlueCard and Consortium Transfer pricing and acts as point of contact for pricing and other interPlan questions. Researches and leads or participates in the resolution of issues, including those identified in the Unmatched report. Establishes processes and reports to validate payments are consistent with InterPlan agreements and to verify fee arrangements are in accordance with BCBSA and Consortium Health Plan pricing policies. Works with other areas to ensure appropriate SOPs and controls are in place to administer interPlan functions.
Supports Sales in discount analytics by providing geo- access reports, ValueQuest reports, attribution and other Value Based Program reports, and/or provider disruption reports using tools available through BlueWeb, BCBSA or CHP or other sources.
Responsible for tracking and reporting on Home and Host OOA enrollment by Plan and/or Account, researching and reporting on variances from plan and trending over time.
Participates in special projects as requested, such as support of: ASO billing for Away From Home Care claims and monthly financial summaries; Prefix Account ID implementation; responses to informational requests from BCBSA, CHP or others.
Provides analysis of LG SBU financial results and variances as requested.
QUALIFICATIONS / REQUIREMENTS:
Required: Bachelor’s degree, or equivalent technical training and 5+ years of accounting/financial experience. Excellent PC skills using Microsoft Office products, including experience with data analysis.
Department: Large Group Budget & Administration
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: 11/22/2018
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 relate to capabilities required to perform the essential duties and responsibilities of the position. Requirements may be modified to accommodate individuals with disabilities. The employee is primarily seated, with occasional walking or standing. 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. Travel among CareFirst sites may be required.
Sponsorship in US
Must be eligible to work in the U.S. without Sponsorship