Quality Control Business Analyst

PacificSource • Springfield, OR

1d • Onsite

About The Position

PacificSource is seeking a Quality Control Business Analyst to audit and report on the accuracy of enrollment and billing transactions and processes across Operations. This role collaborates with IT, Facets Business Support, Finance, and external vendors to support configuration updates, system interfaces, and reporting. The analyst will ensure compliance with Federal and State Exchange guidelines, assist with reconciliation of accounts receivable, eligibility, and billing, and recommend and implement process improvements to enhance operational efficiency and data integrity.

Requirements

• 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.
• Strong keyboarding and 10-key skills 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.
• 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.

Nice To Haves

• Accounting experience is preferred.
• Associate’s degree preferred.

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.
• 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.

Benefits

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED