Quality Control Business Analyst

PacificSource Health Plans is dedicated to helping members access quality, affordable care. The Quality Control Business Analyst will conduct audits, ensure compliance with federal and state guidelines, and collaborate with various teams to enhance operational efficiency and data integrity.

What you'll do:

• 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

What they're looking for:

• 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
• High school diploma or equivalent required
• 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
• Accountability, Collaboration, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork
• Accounting experience is preferred
• Associate's degree preferred