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Quality Control Business Analyst

PacificSource Health Plans -
Springfield, OR

Apply Now

Job Details

Full-time
$44,982.98 - $71,972.77 a year
3 days ago

Benefits

Health insurance

Qualifications

Customer communication
Spreadsheets
Employee relationship building
English
High school diploma or GED
Typing
10 key typing
Stakeholder relationship building
Excel data analysis

Full Job Description

Looking for a way to make an impact and help people?

Join PacificSource and help our members access quality, affordable care!

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, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths.

Audit and report on the accuracy of enrollment and billing transactions and processes across Operations. Collaborate with IT, Facets Business Support, Finance, and external vendors to support configuration updates, system interfaces, and reporting. Ensure compliance with Federal and State Exchange guidelines, and assist with reconciliation of accounts receivable, eligibility, and billing. Recommend and implement process improvements to enhance operational efficiency and data integrity.

Essential Responsibilities:

Conduct audits of operational job functions; document findings; maintain audit records and prepare reports for management.
Perform monthly accounts receivable reconciliations across all lines of business; ensure timely reporting to Finance.
Reconcile Exchange enrollment and billing reports; resolve discrepancies in collaboration with CMS and State Exchanges.
Support Membership Representatives in resolving group account discrepancies, particularly when payments differ from billed amounts.
Partner with reporting teams to develop, test, and maintain reports; assess impacts of configuration changes and request ad hoc reports as needed.
Assist IT and Facets Business Support in testing and validating configuration and interface changes, including 834 files and other member data exchanges.
Identify and resolve data issues in member files; monitor new processes for efficiency and effectiveness.
Convert student health insurance rates to daily rates for system entry; validate accuracy with Underwriting.
Prepare and reconcile daily lockbox spreadsheets and cash receipts; investigate and resolve discrepancies with Finance and third-party vendors.
Monitor pending payment accounts; maintain tracking tools such as SharePoint and assist with TPA spreadsheet setup and macro updates.
Validate ACH Debit files prior to bank submission.
Resolve enrollment and eligibility issues to support accurate claims processing.
Collaborate with MarCom and IT to create and troubleshoot member communication letters.
Develop, update, and maintain departmental procedures and documentation.
Contribute to process improvement initiatives to enhance operational efficiency and data integrity.
Review the Exchange enrollment and billing reports (daily, weekly, monthly); facilitate reconciliation to comply with the Federal and State Exchange guidelines.

Supporting Responsibilities:

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

SUCCESS PROFILE

Work Experience: Minimum of 1 year of Enrollment and 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 experience are required. Accounting experience is preferred.

Education, Certificates, Licenses: High school diploma or equivalent required. Associate’s degree preferred.

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.

Competencies

Adaptability

Building Customer Loyalty

Building Strategic Work Relationships

Building Trust

Continuous Improvement

Contributing to Team Success

Planning and Organizing

Work Standards

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

Skills:

Accountability, Collaboration, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork

Compensation Disclaimer

The wage range provided reflects the full range for this position. The maximum amount listed represents the highest possible salary for the role and should not be interpreted as a typical starting wage. Actual compensation will be determined based on factors such as qualifications, experience, education, and internal equity. Please note that the stated range is for informational purposes only and does not constitute a guarantee of any specific salary within that range.

Base Range:

$44,982.98 - $71,972.77

Our Values

We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:

We are committed to doing the right thing.
We are one team working toward a common goal.
We are each responsible for customer service.
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-internally and externally.
We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
We encourage creativity, innovation, and the pursuit of excellence.

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.

Apply Now

Refine Your Search

claims processing jobs in springfield, or

Quality Control Business Analyst

Customer Service Team Leader

Accounting Assistant

Human Resources Manager

Pharmacy Technician II

Medical Billing Director - 5709

Educational Assistant, Special Education (Significant Needs ) - Edison Elementary

Educational Assistant, Special Education (Significant Needs ) - Chávez Elementary

Educational Assistant, Special Education (Significant Needs ) - Adams Elementary

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Special Education Teacher (Life Skills)

Bilingual Educational Assistant - River Road/El Camino del Rio Elementary

Pharmacy Operations Manager

Manager Claims Casualty

Casualty Specialist II

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