ASO Invoicer I

Capital Blue Cross has built a reputation as being “more than” a health insurance company. We are an industry and community leader that understands the foundation of our success is serving people—addressing their needs, guiding them through their health and wellness journey, exceeding their expectations, and giving back to the communities we serve. We could not accomplish these goals without our employees, which is why we work so hard to provide a positive, supporting culture that encourages and rewards excellence. Capital Blue Cross offers competitive pay, bonus opportunities, quality benefits, health and wellness incentives, and opportunities for career advancement and community involvement. Our positive workplace culture and employee involvement in our communities have earned us recognition as one of The Best Places to Work in PA and Corporate Citizen of the Year. The success of our company relates directly to the efforts of our dedicated workforce made up of talented individuals, who understand that a career at Capital Blue Cross is “more than” simply a job. To experience that kind of opportunity, consider applying to join our fearless team. As a federal contractor, employees of Capital Blue Cross are required to be fully vaccinated against COVID-19 unless approved for a medical or sincerely held religious belief exemption. Please ask your recruiter for more information. 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. Duties and Responsibilities: 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. Capital Blue Cross is an independent licensee of the Blue Cross Blue Shield Association. We are an equal opportunity/affirmative action employer and do not discriminate on the basis of race, color, religion, national origin, gender, sexual orientation, gender identity, age, genetic information, physical or mental disability, veteran status, or marital status, or any other status protected by applicable law.