Company :HM Insurance GroupJob Description :
JOB SUMMARY:
This job is responsible for the claims invoicing and accounts receivable activities for the non-risk self-insured population of clients supporting all medical, buy-up, shared savings, drug, branded and non-branded dental, and spending account products. The client population will include a portfolio of more complex structure and reporting. Support onboarding and training of new team members as well as cross-training on all billing/AR functions; providing value-added actionable feedback to leadership for performance management. This job will perform reviews by auditing all changes in the system that will impact the billing and/or accounts receivable activity for the self-funded customer base; coordinate, plan and perform various specialized tasks related to the collection and recovery of weekly receivables; review and analyze daily and weekly management/trending reports; run and modify advanced (SQL) queries based on customer specific needs and to support internal statistical requests; reconcile and analyze payment activity for advanced self-billed administrative clients to ensure compliance with audit thresholds; must be able to interact well with a diverse cross-functional set of internal stakeholders (Sales, Information Technology, Management, Finance/Accounting, Underwriting) as well as external stakeholders; recommend and implement process improvements, acting as a subject matter expert on various projects and initiatives; must be able to work in a fast-paced environment with daily work processing deadlines; and follow and ensure team compliance with all HIPAA and HITECH guidelines pertaining to Protected Health Information (PHI).
ESSENTIAL RESPONSIBILITIES:
- Perform quality control reviews by auditing all changes in the systems that will impact the billing and/or accounts receivable activity for the self-funded customer base; coordinate, plan and perform various specialized tasks related to the collection and recovery of weekly receivables; review and analyze daily and weekly individual client and departmental management/trending reports.
- Perform billing, A/R and reporting functions in support of more complex self-funded customers including; ensure timeliness and accuracy of invoices using reasonableness and/or comparative assessments and judgment for a specific customer portfolio, utilize trending reports to validate completeness and data integrity associated to the invoice and A/R cycle; ensure all rate discrepancies, self billed administrative, and payment allocation reconciliations are prepared, finalized and executed in a timely manner to support the weekly billing cycle; monitor customer receivables and coordinate collection efforts; maintain customer profiles, create and maintain electronic user access; run and modify advanced (SQL) queries based on customer specific needs and to support internal statistical requests; reconcile and analyze payment activity for advanced self-billed administrative clients to ensure compliance with audit thresholds.
- Required to participate in special projects or activities identified by management. Propose automation solutions to manual tasks and make recommendations to enhance efficiency around current processes. Assist leadership to ensure integrity of data upon implementation of new process; update control procedures, as necessary, to maintain checks and balances. Support onboarding and training of new team members as well as cross-training on all billing/AR functions; providing value-added actionable feedback to leadership for performance management. Facilitate new client financial implementation meetings.
- Other duties as required.
EDUCATION
Required
- High School Diploma/GED
Substitutions
- None
Preferred
- Bachelor’s Degree
EXPERIENCE
Required
- 5 years of subject matter experience in the area of specialization
Preferred
- None
SKILLS
- Must interact well with a cross-functional group of internal and external stakeholders such as; Sales, System Support, Management, Finance/Accounting, Underwriting and Clients.
- Must be able to work in a fast-paced environment with daily work processing deadlines
- Demonstrate personal accountability
- Ability to develop specific skills and a broader knowledge of all departmental functions as a subject matter expert
- Ability to think strategically and act proactively under pressure independently and as a part of a team
- Strong innovative problem-solving capabilities, ability to demonstrate forward thinking and make recommendations for resolution
- Ability to lead department level projects
- Strong proficiency with Microsoft Office products (i.e. Word, Excel, Powerpoint, Outlook etc.)
Language (Other than English):
None
Travel Requirement:
0% - 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Position Type
Office-based
Teaches / trains others regularly
Occasionally
Travel regularly from the office to various work sites or from site-to-site
Rarely
Works primarily out-of-the office selling products/services (sales employees)
Never
Physical work site required
Yes
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Occasionally
Lifting: 25 to 50 pounds
Rarely
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.
Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
Pay Range Minimum:
$21.53
Pay Range Maximum:
$32.30
Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
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For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org
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Top Skills
What We Do
Highmark Health, a Pittsburgh, PA based enterprise that employs more than 40,000 people who serve millions of Americans across the country, is the second largest integrated health care delivery and financing network in the nation based on revenue. Highmark Health is the parent company of Highmark Inc., Allegheny Health Network, and HM Health Solutions. Highmark Inc. and its subsidiaries and affiliates provide health insurance to nearly 5 million members in Pennsylvania, West Virginia and Delaware as well as dental insurance, vision care and related health products through a national network of diversified businesses that include United Concordia Companies, HM Insurance Group, and Visionworks. Allegheny Health Network is the parent company of an integrated delivery network that includes eight hospitals, more than 2,800 affiliated physicians, ambulatory surgery centers, an employed physician organization, home and community-based health services, a research institute, a group purchasing organization, and health and wellness pavilions in western Pennsylvania. HM Health Solutions focuses on meeting the information technology platform and other business needs of the Highmark Health enterprise as well as unaffiliated health insurance plans by providing proven business processes, expert knowledge and integrated cloud-based platforms.
A national blended health organization, Highmark Health and our leading businesses support millions of customers with products, services and solutions closely aligned to our mission of creating remarkable health experiences, freeing people to be their best.
Headquartered in Pittsburgh, we're regionally focused in Pennsylvania, Delaware, West Virginia and New York, with customers in all 50 states and the District of Columbia.
We passionately serve individual consumers and fellow businesses alike. Our companies cover a diversified spectrum of essential health-related needs, including health insurance, health care delivery, population health management, dental solutions, reinsurance solutions, and innovative technology solutions.
We’re also proud to carry forth an important legacy of compassionate care and philanthropy that began more than 170 years ago. This tradition of giving back, reinvesting and ensuring that our communities remain strong and healthy is deeply embedded in our culture, informing our decisions every day.
