Full-Time Reconciliation Analyst

Base pay is influenced by several factors including a candidate’s qualifications, relevant experience, and anticipated contributions to meet the needs of the business, along with internal pay equity and external market driven rates. The salary range displayed has not been adjusted for geographical location. This range has been created in good faith based on information known to Capital Blue Cross at the time of posting and may be modified in the future. Capital Blue Cross offers a comprehensive benefits packaging including Medical, Dental & Vision coverage, a Retirement Plan, generous time off including Paid Time Off, Holidays, and Volunteer time off, an Incentive Plan, Tuition Reimbursement, and more.

At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.”

This position is responsible for providing analytical, technical and problem resolution to support researching and resolving enrollment and payment discrepancies between Pennie (Pennsylvania’s State Based Exchange) and the Capital for Exchange members receiving advance premium tax credits (APTC) as permitted through the Affordable Care Act (ACA).

Primary focus will be to research discrepancies, assist in identifying root cause/problem, and track activities associated with the reconciliation process. Coordinate corrections with the Pennie as needed so that Facets and Pennie systems are in sync.

Responsibilities And Qualifications

• Analyze enrollment, payment and billing issues in Facets, determine impact and identify solutions.
• Interact with Pennie to communicate and resolve enrollment and/or payment issues.
• Identify billing issues and trends for increases/decreases in frequencies and report to management, including development and/or execution of system enhancements.
• Track downstream updates and changes in the reconciliation process to ensure all premiums due are collected.
• Identify and/or document detailed business requirements to support configuration and system changes.
• Establish and maintain working relationship with internal contacts (i.e. Account Administration and IT&D).
• Participate in Pennie calls regarding Enrollment, Billing and Reconciliation.
• Responds to billing and payment questions from internal and external customers. Ability to document processes and procedures.
• Participate in monthly Reconciliation Team Unit meeting to discuss trends identified and resolutions
• Maintain an understanding of Pennie payment/reconciliation guidelines and requirements and operate accordingly to assure compliance and ensure that all payment related functions are accurate.

Skills

• Ability to analyze problems and issues, determine impact and develop business solutions for system changes. Ability to act as a liaison and recommend solutions to a variety of departments as well as external business partners.
• Proven problem-solving ability with a creative initiative to make sound business decisions.
• Strong written and verbal communication skills. Ability to communicate effectively both verbally and in writing with a variety of audiences.
• Demonstrated ability to manage large volumes of work, solve problems and manage multiple assignments while meting critical deadlines.
• Demonstrated ability to work independently and to plan/organize workload.
• Ability to give presentations to both management and staff. Includes the ability to develop teamwork among diverse groups.

Knowledge

• Familiarity with healthcare insurance industry, health delivery systems, and the business environment in which they exist.
• Knowledge of data processing terminology and concepts. Includes a high-level technical understanding of technologies such as Microsoft Office Suite, Crystal Reporting, Data Modeling and Intranet Technology as well as knowledge of batch and real-time processing environments.
• Knowledge of Pennie enrollment and reconciliation files/data including Facets look up, daily 834 file research, review of reconciliation files and analysis of the audit files (monthly 834 file) from Pennie.

Experience

• 3 years' relevant experience.
• Experience with PC-based software packages (Word, Excel, Access, and PowerPoint) to perform research/analysis/project tasks.
• Experience with operational processing systems utilized throughout Capital’s business operations such as FACETS, eCIS and other Pennie Reconciliation support tools.

Education And Certifications

• High school diploma or equivalent.
• Prefer a bachelor’s degree in one of the following: business administration, information systems, computer science.

Physical Demands

• While performing the duties of the job, the employee is frequently required to sit, use hands and fingers, talk, hear, and see.
• The employee must occasionally lift and/or move up to 5 pounds.