Insurance Accounting Specialist - Peak Health

Overview

Provides financial, administrative, and clerical support within the Accounting/Finance department. Responsibilities include review and processing of vendor invoices, provider payments, and voids and reissues of provider payments.

• Associates' Degree in finance, accounting or business related field
• Two (2) years of accounting or finance related experience

• Premium Billing – processes the monthly premium billing cycle for ASO PEPM fees and Medicare Advantage enrollees, reconciles invoices and premium receipt reports to premium billing reports, reconciles and applies payments received for premium invoices.
• CRM Responsibilities – researches, resolves and communicates resolution to internal team as well as external vendors for any finance related customer relationship management (CRM) request(s).
• Claims Funding – communicates weekly claims funding totals for both capitated and non-capitated claims to ASO clients as part of the weekly claims settlement process.
• Claims Settlement Analytics – provides management with weekly claims settlement analytics and reports.
• Manages vendor information for accuracy relating to address and banking information to ensure payments to vendors are received and/or processed in a timely fashion.
• Compiles and processes accounts payable, maintains day to day payment cycle, and provides efficient customer service, ensuring all Medicare Advantage claims are settled and processed in a timely manner to avoid penalty.
• Verifies approval on all vendor payment requests.
• Processes payments to contracted providers for claims submitted to and processed by the Claims Operations department.
• Resolves problems associated with vendor payables transactions.
• Reconciles processed work by verifying entries and comparing system reports to balances.
• Provides accurate and effective document preparation and records management relative to the Claims Payable function in accordance with records retention policies and procedures, and any federal regulations.
• Maintains relationships with all areas of the organization to ensure effective, efficient, and accurate workflow processes as it relates to claims processing and customer service to both internal and external clients.
• Protects organization's value by keeping information confidential, adhering to all HIPAA regulations.
• Updates job knowledge by participating in educational opportunities.
• Maintains historical records by imaging and filing documents.

• Manual dexterity used in operating standard office equipment.
• Prolonged periods of sitting.
• May be required to walk to various areas throughout the department or medical complex, may require use of elevators and/or stairs.
• Occasionally lifts up to 15 lbs.
• Must be able to use a computer, answer the telephone and use other office equipment (fax, copier, printer).

• The employee will be working in an office environment.

• Ability to work with computers.
• Flexible and detail oriented.
• Organized and professional.

HYBRID (2-3 days on-site) Morgantown, WV – will be working with health plan.

40

Exempt/Non-Exempt:
United States of America (Non-Exempt)

PHH Peak Health Holdings

541 PHH Accounting