Qualifications

• 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.

Duties And Responsibilities

• 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 (5^th) business day of the month.
• Assist with Mid-Month cash application audit that must be completed by the 15^th 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 HealthCare 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 overpayments 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 improvements and innovation by raising concerns and offering suggestions for enhancements and implementation.
• Create and document Standard Operating Procedures (SOP’s).
• Perform ledger reconciliations to ensure accuracy and compliance with financial records.

• Work with Eligibility Specialists to research/resolve unpaid and/or outstanding balances for PCMI employer groups, and COBRA/Retiree accounts.
• Act as a liaison to other departments for resolution of issues that may arise.
• Provide timely and effective customer service to clients by addressing requests, inquiries, and issues related to customer accounts.
• Serve as representative of PCMI and WGH displaying professionalism, knowledge, customer service and discretion in all interactions with other members of PCMI and WGH community and their customers.
• Get curious and strive to understand others’ outside triangles, (what they are needing/wanting to do).
• Plan and execute work in a helpful and collaborative manner.
• Be accountable for helping assess and report performance in terms of impact, making improvements, and course correcting along the way.
• Consistently meet processing cycle time standards and production due dates.
• Mentor Customer Accounting Specialist I.

• Utilize all capabilities to satisfy one mission — to enhance the competitiveness and profitability of our members. Do everything possible to help members succeed by being curious and striving to understand what others are trying to achieve, planning, and executing work helpfully and collaboratively. Be willing to adjust efforts to ensure that work and attitude are helpful to others, be self-accountable, create a positive impact, and be diligent in delivering results.
• Maintain internet speed of 40 MB download and 10 MB upload and router with wired Ethernet.
• Maintain a HIPAA-compliant workstation and utilize appropriate security techniques to ensure HIPAA-required protection of all confidential/protected client data.
• Maintain and service safety equipment (e.g., smoke detector, fire extinguisher, first aid kit).
• All other duties as assigned.  

Physical Demands/ Work Environment

The physical demands and work environment described here are representative of those that must be met by an employee to perform the essential functions of this job successfully. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to communicate with others. The employee frequently is required to move around the office. The employee is often required to use tools, objects, and controls. This noise level in the work environment is usually moderate.

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