PacificSource Health Plans

  • Business Analyst I - CEB

    Job Location US-OR-Springfield
    Job ID
    Regular Full-Time
    Hiring Pay Range
    $18.50 - $19.50/HR
    # of Openings
  • Overview

    Position Overview:


    Audit, evaluate, and report the accuracy of department transactions and processes and make recommendations for process improvement. Assist with audits for group accounts that are not reconciled, on an as-needed basis. Work as member of the Lockbox support team to ensure daily accounts receivable are reconciled. Work with the Business Analyst II to ensure testing, auditing, and department processes are completed according to department standards. Complete monthly accounts receivable reconciliation for Individual, Fully Insured Groups, Self-Funded Groups and Exchange lines of business. Work with IT, Facets Business Support, and external vendors on configuration changes, interfaces, and reports.


    Essential Responsibilities:

    1. Perform audits of job functions as determined necessary by Manager. Document outcomes of audits and prepare reports for Manager and Team Leaders. Create and maintain documentation on audit processes.
    2. Complete month end A/R reconciliation for all lines of business. Ensure month-end reconciliation and reporting meet Finance’s delivery deadline.
    3. Assist Membership Representatives with reconciling groups that do not pay as billed.
    4. Work with reporting team to develop and test new reports. Identify and test new and existing reports impacted by configuration changes. Communicate the report changes and the additional reporting needed to Manager and Team Leaders. Request reports and queries on an as needed basis to assist with identifying and resolving discrepancies.
    5. Assist IT with testing and validation of interface changes and defects. Work with outside vendors when interface is used to communicate member data, such as 834 vendors. Provide key support in implementation of new and maintenance of existing 834 files. Diagnose and resolved data issues on files.
    6. Assist with testing and monitoring of new processes to ensure efficiency and effectiveness. Assist Facet Business Support with testing and validation of configuration changes to core system.
    7. Convert the sold school term rates for student health insurance plans into daily rates for purposes of entry into Facets. Work with Underwriting Manager to ensure the daily rates are correct.
    8. Work as a member of the Lockbox Support Team to prepare the daily lockbox spreadsheets for Membership processing. Investigate and correct any errors encountered during the daily reconciliation process, and resolve any discrepancies with Finance and/or third party vendor.
    9. Complete daily cash receipts reconciliation.
    10. Complete monthly Exchange enrollment and billing reconciliations. Resolve disputes and discrepancies with the Enrollment Resolution and Reconciliation contractors with CMS.
    11. Monitor the pending payment account 2304 and update SharePoint.
    12. Assist with set up of new TPA Spreadsheets. Update the TPA template macros as needed.
    13. Validate monthly ACH Debit file prior to Finance department sending to the bank.
    14. Assist with the development and implementation of process improvement initiatives.
    15. In order to facilitate claims processing assist Facets Business Support and Claims by resolving enrollment & eligibility issues.
    16. Work with Facets Business Support, MarCom, and IT to create new letters and resolve letter issues.
    17. Create, edit and review procedures to support all teams in the department.



    Supporting Responsibilities:


    1. Develop and maintain positive working relationships with Commercial Enrollment & Billing Department staff, other employees, external partners, customers, and vendors based on open communication, interacting in a supportive capacity, and treating all with respect.
    2. Participate in committees and/or projects as assigned.
    3. Provide assistance as needed for the Commercial Enrollment & Billing Department.
    4. Meet department and company performance and attendance expectations.
    5. Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
    6. Perform other duties as assigned.



    Work Experience: A minimum of two years Commercial Enrollment & Billing experience and/or business analysis experience required. Advanced level experience using Excel, creating spreadsheets, using formulas, pivot tables and performing data comparisons required. Strong research and troubleshooting skills are required. Accounting experience is preferred.


    Education, Certificates, Licenses: Associate’s degree in business or accounting or 2 years additional business work experience required.


    Knowledge: Ability to gain understanding of PacificSource products, plan designs, group contracts, eligibility guidelines, billing functions, accounts receivable, and health insurance terminology. Ability to gain knowledge of the Eligibility and Billing Analyst, and Membership Representative I & II positions. Ability to work independently as well as within a team. Strong keyboarding and 10-key skills required.




    Our Values

    ·         Adaptability

    ·         Building Customer Loyalty

    ·         Building Strategic Work Relationships

    ·         Building Trust

    ·         Continuous Improvement

    Contributing to Team Success

    Planning and Organizing                      

    ·         Work Standards



    • We are committed to doing the right thing.
    • We are one team working toward a common goal.
    • We are each responsible for our customers’ experience.
    • We practice open communication at all levels of the company to foster individual, team and company growth.
    • We actively participate in efforts to improve our many communities-internal and external.
    • We encourage creativity, innovation, continuous improvement, and the pursuit of excellence.



    Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 5% of the time.


    Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions.  Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.


    Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.


    PacificSource is an equal opportunity employer.  All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.





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