Financial Specialist II

JOB DESCRIPTION SUMMARY

This position reports to the Senior Supervisor, Administration Finance and requires the ability to process financial transactions, both automated and manual, within the company’s processing systems, including group and individual billing, Automated Clearing House (ACH) transactions, and cash receipt processing. Maintain and balance group and individual accounts receivables including delinquency processing and terminations. Manage receipt of group admin fees and process vendor payments.

Invoice for third party administrator (TPA) Claims processing and manage receipt and application of claims funding.

• BA/BS degree in accounting, finance, or business-related field and three (3) to five (5) years of experience working in a related field or equivalent combination of education and experience preferred.
• Skills to establish priorities, multi-task, work under pressure and deadlines, work independently with minimal supervision or in team environment.
• Proficient in Microsoft applications, including intermediate skills in Excel, Word, and Outlook.
• Experienced in performing customer account reconciliations, including research, and resolving discrepancies with minimal supervision.
• Excellent written and oral communication skills, to include modern business communications, formatting professional letters, reports, and phone etiquette.
• Customer service oriented.
• Ability to analyze and resolve technical problems and/or client inquiries as they arise.
• Knowledge of generally accepted Health Care Eligibility and Billing procedures as well as Health Insurance Portability and Accountability Act (HIPAA), Consolidated Omnibus Budget Reconciliation Act (COBRA), Cal-COBRA, Multiple Employer Welfare Arrangement (MEWA) and Employee Retirement Income Security Act (ERISA) regulations.
• Knowledge of health insurance industry.
• Ability to work overtime as requested by management and based upon department needs and compliance.
• Internet access provided by a cable or fiber provider with 40 MB download and 10 MB upload speeds.
• Home router with wired Ethernet (wireless connections and hotspots are not permitted).
• A designated room for your office or steps taken to protect company information (e.g., facing computer towards wall, etc.).
• A functioning smoke detector, fire extinguisher, and first aid kit on site.

• Customer Account Management & Maintenance:
  Maintain/manage all Pinnacle Claims Management, Inc. (PCMI) contribution/premium reimbursements, COBRA/Retiree reimbursements, and vendor pass thru payments for PCMI.
• Verify and authorize the release of PCMI vendor payment within four business days of account funding.
• Manage the process of funding and releasing self-funded claims payments.
• Reconcile and maintain accuracy of group ledger accounts by matching incoming payments to corresponding invoices, promptly investigating and resolving discrepancies, collaborating with internal teams and external partners to make adjustments, and maintaining thorough documentation to support audit trails.
• Monitor bank accounts daily for returned items, overdrafts, positive pay exceptions, stop payments and other exception reporting and make decision for resolution or escalation. Month End Financials completed and delivered to Accounting by the fifth (5th) business day of the month.
• Assist with Mid-Month cash application audit that must be completed by the 15th business day of the month.
• Manage and maintain Bank lockbox, and ACH/Wire programs.
• Manage and maintain retiree invoicing & receivable management program(s).
• Support FSA (Flexible Spending Account) HSA (Health Savings Account) HRA (Health Reimbursement Arrangement) program.
• Manage the delinquency process for both WGH & PCMI accounts.
• Manage the third-party pharmacy process by reviewing consumer claim data files from vendors and coordinating billing and invoicing between operational and accounting teams to ensure accurate and timely payments. Validate and audit pharmacy data files against contract pricing, documenting, and reporting findings. Additionally, ensure files are audited and loaded promptly.
• Process and verify the necessary corrections on manual adjustments posted to group ledger on Health Care Processing System for PCMI, Western Growers Health (WGH) and individual accounts (COBRA)/Retiree.
• Perform bank reconciliations for customer accounts and initiate ledger adjustments as needed.
• Verify/authorize refund for terminations and over payments on all accounts.
• Apply cash to appropriate ledgers and research /correct application issues.
• Provide back-up resource for invoice generation, daily cash application and other customer accounting duties.
• Process related written and verbal account inquiries to its conclusion in a timely manner to include research on as needed basis.
• Prepare ad hoc reports upon request.
• Proactively identify inefficiencies within established processes and recommend solutions to optimize time, reduce risk, and minimize cost. Contribute to process…