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.”  

The position is responsible for the preparation of ASO (Administrative Services Only) and CDH group invoices and letters that include medical and vendor claims plus additional administrative charges and other fees. The incumbent is responsible for tracking payments, and the production of special request ASO group invoicing reports. The incumbent researches, and resolves rate, payment, and claim discrepancies as requested by Account Administration Operations, Marketing, Underwriting and Rating, and Finance/Accounting personnel. Acts as a liaison between various units in the department to coordinate the resolution of requests/inquiries regarding group problems, and researches requests to move claim utilization from one group to another. Responsible for reviewing detailed data that is the main component of an ASO group's invoice. Responsible for completing invoices and compiling supporting documentation consistent with the control requirements established for the SSAE16 and MAR audit processes. Monitors all billing components to ensure all pieces are billed and documented.

• Prepares invoices for AFA/ASO and CDH accounts under strict time constraints. Responsible for ensuring the receipt of all necessary information and validating this information for accuracy in order to prepare the invoices.
• • 30% Researches and coordinates the resolution of rate discrepancies reported by finance/accounting personnel.
  • 5% Researches and resolves payment discrepancies/inquiries between billing entities in Facets. Logs the receivable on the appropriate control and prepares the entry for Accounting services to insure accurate recording of transaction.
  • 10% Researches and resolves group problems reported by Operations personnel such as rate discrepancies, Product inconsistencies, enrollment and benefit discrepancies and HIPAA conflicts.
  • 10% Researches and updates group information utilized by the unit (i.e. paper build, invoice letter, spreadsheets, etc.), retention percentages, stop-loss and premiums on a personal computer.
  • 5% Works with Rating to coordinate billing/crediting of cost rate adjustments.
  • 10% Ability to research, verify and review SSR’s to ensure that groups are receiving and are being billed accurately and to communicate missing information that is needed for verification/clarification
  • 5% Develops and produces various ad hoc utilization reports as requested by group accounts.
  • 10% Researches requests from group accounts and/or another area within CBC in regards to claim utilization, and set-up.
  • 5% Responsible for training with in the unit of cross functions (i.e. control person, Access validation, CDH group set up and QC).

Skills:

• Familiar with all financial aspects of ASO accounts (i.e., advances, letters of credit, rating types, stop-loss, vendors, etc.) for CBC.
• Demonstrates the ability to perform arithmetic, percentage and statistical calculations
• Excellent organizational skills and ability to schedule own work, adapt to changing priorities to meet deadlines while under strict time constraints.
• Assists in special projects as assigned.
• Ability to work independently as well as part of a team.
• Ability to analyze various financial and billing reports.

Knowledge:

• Knowledge of the ASO system to request claims data, prepare invoices and letters on personal
• Computer, track payments with Accounting and Account Administration, etc.
• Knowledge of ASO adjustments and the ability to apply and explain these to ASO accounts.
• Knowledge of the rate renewal process so that rates can be verified and rate discrepancies can be resolved.
• Familiar with the processes involved in establishing new groups and changing the benefits of existing groups.
• Knowledge of the Facets, ASO Vendors and the group account reporting processes to accurately research group reporting.

Experience:

• Demonstrates a proficient ability to utilize a personal computer and various software packages (i.e., Facets, Microsoft Word, Excel, Access), with the ability to produce standard and customized reports.  Demonstrates the ability to communicate effectively and professionally via telephone, voice mail, electronic mail, in person and in writing.

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 be able to work over 40 hours per week. The employee must occasionally lift and/or move up to 5 pounds.

We recognize that work is a part of life, not separate from it, and foster a flexible environment where your health and wellbeing are prioritized. At Capital you will work alongside a caring team of supportive colleagues, and be encouraged to volunteer in your community.  We value your professional and personal growth by investing heavily in training and continuing education, so you have the tools to do your best as you develop your career. And by doing your best, you’ll help us live our mission of improving the health and well-being of our members and the communities in which they live.