The Billing Operations Analyst is responsible for generating all State premium revenue across all product lines. The individual will be responsible for ensuring operational effectiveness, coordinating completion and submission to the New York State Department of Health with the IT department for State revenue and ensure all supporting revenue & remittance data has been loaded to the data warehouse for reconciliation and recording.
Duties and Responsibilities:
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Generate and review the State billing files for all Healthfirst products. Ensure billed records are accurate based on approved contracted rates from Department of Health and correct any errors from exception reports.
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Ensure State billing files are loaded to the data warehouse following completion of billing process.
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Identify and bill kick events (Maternity, Newborn and Low Birth Events).
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Prepare monthly Child Health Plus (CHP) State voucher for submission to State.
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Review, analyze and create all General Ledger (GL)reports monthly (e.g., Revenue, AFDA; Write offs).
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Ensure supporting revenue (e.g., write off data) is loaded to the data warehouse monthly.
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Ensure State remittance files are loaded weekly and communicate any discrepancies to management in a timely manner.
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Research and rebill denied claims across all products.
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Submit refunds to the Department of Health for Retro Disenrollment/VOID reports.
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Additional duties as assigned.
Minimum Qualifications:
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Associate's degree from an accredited institution.
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Prior work experience performing billing and accounts receivable functions.
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Experience communicating information in both technical and user-friendly language.
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Must have Excel experience, the ability to create and manipulate data using pivot tables, as well as perform VLOOKUP functions.
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Experience with SAS or SQL is a plus.
Preferred Qualifications:
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Bachelor's degree from an accredited institution.
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Ability to effectively communicate with all levels of the organization, including technical staff, internal non-technical staff, testing teams, and business stakeholders.
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Ability to meet department standards of turnaround time and quality.
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Ability to effectively and efficiently work in an environment of high-level performance.
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Ability to challenge the status quo and drive lean implementation.
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Excellent organization and time management skills to manage heavy workload and produce accurate information.
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Advanced problem-solving skills and the ability to make critical, independent decisions within area of responsibility.
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-Ability to quickly develop an understanding of systems and technology.
Compliance & Regulatory Responsibilities: N/A
License/Certification: NA
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.
If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to [email protected] or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.
EEO Law Poster and Supplement
All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process.
Hiring Range*:
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Greater New York City Area (NY, NJ, CT residents): $57,400 - $78,030
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All Other Locations (within approved locations): $49,800 - $74,120
As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.
In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.
*The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.
Top Skills
What We Do
Healthfirst is a provider-sponsored health insurance company that serves 1.8 million members in downstate New York. Healthfirst offers top-quality Medicaid, Medicare Advantage, Child Health Plus, and Managed Long Term Care plans. Healthfirst Leaf Qualified Health Plans and the Healthfirst Essential Plan are offered on NY State of Health, The Official Health Plan Marketplace. Healthfirst offers Healthfirst Pro and Pro Plus, Exclusive Provider Organization (EPO) plans for small-business owners and their employees, and Healthfirst Total, an EPO for individuals.
For more information on Healthfirst, visit www.healthfirst.org
