Research and Financial analysis Performs complex financial analysis with minimal supervision and report findings to management. Reviews and reconciles medium to high complexity balance sheet accounts. This includes, but is not limited to, cash, revenue, receivable, expense, and liability accrual accounts. Analyze financial data for significant fluctuations and communicate with appropriate units or departments to ascertain validity of transactions. Analyze, research, and communication financial information to management or leadership. Prepares and provides account reconciliations, audit workpapers, and other documentation for internal and external audit reviews. Federal and State compliance reporting support Provides support for Federal and State compliance reporting requirements such as Federal Plan (FEPDO and OPM) reporting requirements, HIPAA compliance guidelines, Federal escheat requirements, State Unclaimed property reporting requirements, IRS 1099 reporting requirements, and any other new or updated regulatory mandates. Ability to interpret government rules and regulations Communicate with vendors and business associates on updated or new reporting requirements. Manages and coordinates work effort for updates to compliance guidelines including but not limited to HIPAA Core Rules, Washington Publishing Company Updates, BCBS Association updates. Review and approval of GL Account Reconciliation / Payment Balancing Review and approve general ledger account reconciliations, claims system payment balancing worksheets, and other internal forms or balancing worksheets as needed. Assist management with review of payment transactions, general ledger reporting and account reconciliation. Manages and coordinates work effort for Disbursements functions such as recovery of provider negative balance, review and reconciliation of medical refunds transactions, processing third party payee requests, monitoring customer inquiry requests, balance, and review payment-related claims transactions. Assist with resolving issues related to payments, refunds, negative balance, deducts, etc. Process Improvement / System Testing Actively participates in projects and provides system test support for corporate initiatives and systems upgrades. Develop business processes, procedures, and workflows for new requirements or business needs for corporate priority initiatives or departmental goals and provide overview and training to staff as needed. Take on leadership role in managing work effort with other department leads to develop, test, and implement solutions. Have direct responsibility and ownership in executing large scale process improvement opportunities within new business launches and existing processes and controls, including defining scope, goals, and deliverables in collaboration with senior leadership and stakeholders. Support all aspects of testing including requirements renew, test case validation and preparing documentation for test acceptance criteria. Ability to trouble-shoot system problems and collect relevant information to solve problem or determine best solution with minimal risk and impact to our customers. Cross-Functional Integration and Communication Effectively communicates with other departments on information related to outstanding balances and the associated claims or remittance information. Coordinate work efforts for audit review and train staff on various business functions. Identify, articulate, and communicate project and accounting operation risks to senior leadership, along with clear recommendations for resolution or mitigation. Performs all other miscellaneous responsibilities and duties as assigned or directed
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