CareFirst Careers

Billing Finance Analyst, TPA

Resp & Qualifications

The incumbent is responsible for maintaining admin rates, preparing and delivering invoices to bring in revenue for the company.  This includes establishing and following required technical specifications, managing the accuracy and efficiency of the established process as well as identifying and resolving data and setup issues as it relates to LuminX and Oracle systems.  The incumbent is also responsible for remitting payment to client vendors within proper timeframes to ensure late fees are not charged. 


Duties And Responsibilities

  • 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.

Competencies
• 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.

Working Environment
This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.


Physical Demands
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.

Position Type/Expected Hours of Work
This is a full-time position.

Travel
No travel is expected for this position.

Required Education and Experience
• Bachelor’s Degree in Accounting, Finance or other math related field. In lieu of a Bachelor’s Degree, an additional 4 years of relevant experience is required.
• 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.

Preferred
LuminX and/or Oracle experience.  Insurance experience.  TPA experience.

Additional Eligibility Qualifications
None required for this position

AAP/EEO Statement
Must be able to effectively work in a fast paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time.  Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence.   Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

Disclaimer
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the associate for this job. Duties, responsibilities and activities may change at any time with or without notice. May be required to perform other related duties as assigned.  The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly to Federal health care programs.

Department

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

Closing Date

Please apply before: 4/5/2020

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.

PHYSICAL DEMANDS:

The associate 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 associate must frequently talk and hear.  Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship

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