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Senior Financial Analyst

2 months ago

Worcester Massachusetts, United States Fallon Health Full time

Overview:

About Fallon Health:
Fallon Health is dedicated to the well-being of our members, ensuring they receive the necessary care they deserve.

Established in 1977 in Worcester, Massachusetts, Fallon is recognized for delivering equitable, high-quality coordinated care and consistently ranks among the top health plans in the nation for member experience, service, and clinical quality.

Our mission is to enhance health and inspire hope, positioning us as the leading provider of government-sponsored health insurance programs—including Medicare, Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)—in the region.

For more information, visit our website or connect with us on social media.

Brief Summary of Purpose:


Under the supervision of the Manager, the Senior Financial Analyst for Premium Billing plays a crucial role in supporting Fallon Health's mission, vision, and values by ensuring the provision and maintenance of timely and precise premium billing information.

Key responsibilities encompass a comprehensive understanding and operation of the Premium Billing department to guarantee the accurate execution of billing cycles, collections, adjustments, and reconciliations.

This includes reconciling subsidy payments from members, CMS, and state agencies. The role involves processing adjustments recorded from member accounts and managing discrepancy reporting and resolution. The analyst will serve as a Subject Matter Expert (SME) for testing core system upgrades and collaborate with staff to review and enhance existing workflows related to accounts receivable processing within the core system.

Additionally, the Senior Financial Analyst will assist the department Director and Manager in developing new metrics to ensure the timely and accurate maintenance of receivable balances.


The analyst is expected to complete tasks accurately and promptly to comply with DOI, CMS, and EOHHS regulations. Concerns should be escalated appropriately, and issues must be followed through to resolution.

For problems not clearly defined by written directives, the analyst will consult with the Enrollment & Billing Operations Manager or Director to determine the best course of action.


The Senior Financial Analyst will work collaboratively with colleagues and other departments to ensure quality service to both internal and external customers.

This includes maintaining a positive attitude toward issues and concerns as they arise and actively identifying and recommending process improvements to the direct supervisor or manager.

The analyst is responsible for ensuring the integrity of information entered and maintained within the QNXT system.

Strong analytical skills are required to assess various situations and make independent decisions that align with the interests of members and the health plan.


Essential prerequisites for success in this role include strong verbal and written communication skills, demonstrated excellence in telephone communication, robust organizational skills, and proficiency in computer applications.

The analyst will perform all necessary functions to maintain accurate subsidiary accounts receivable and ensure the correctness of premium bills. This includes reconciling employer group bills to group payment listings or direct pay member bills and conducting thorough research as needed.

Monthly reviews of Accounts Receivable Summary and Aged Trial Balance will be conducted to identify payment issues.

Collaboration with the leadership team is vital to ensure the completion of monthly and yearly subsidiary accounts receivable and premium billing reports.

The analyst will handle confidential customer information and must possess knowledge of plan policies, protocols, and procedures.

Adaptability in a fast-paced environment with a multi-disciplinary team is essential.

Consistent follow-through on issue resolution and strong multitasking abilities are crucial, along with a sense of accountability and an understanding that job functions may evolve based on business needs.

The analyst is encouraged to pursue self-development through available company and industry educational opportunities.


The Senior Financial Analyst is responsible for enrollment and billing maintenance, adhering to daily, weekly, and monthly schedules along with administrative tasks.



Responsibilities:
Job

Responsibilities:
Maintains receivable balances & Learning/Development


Coordinates the accurate and timely production of all Premium Bill runs with external vendors and serves as backup for group billing when necessary.


Responsible for all daily and month-end reporting, including but not limited to Accounts Receivable Summary, Aged Trial Balance, Credit, and balance forward reporting.

Reviews accounts for refunds and adjustments, ensuring accuracy and compliance with established policies and procedures.

Posts payment files received from state and federal entities to member accounts


Performs reconciliation of accounts receivable to ensure the accuracy and integrity of premiums billed, as well as the appropriate application of premium payments.

This includes preparing outstanding balance reports for the Enrollment & Billing Operations Director, product line owners, and VP of Finance.

Enters and maintains premium rates in the core system

Ensures proper rating categories are reflected in the core system

Proactively works to keep premium billing records current and accurate, ensuring goals and turnaround standards are met or exceeded based on corporate and departmental metrics

Distributes daily ACH, CC, wire, returns, and payment batches for posting by staff.

Receives and processes daily Lockbox and Invoice Cloud payment files.

Acts as the AR liaison with Accounting and IT for inquiries and enhancements

Evaluates the enhancement of Premium Billing operations by analyzing system functionality, procedure documents, and overall productivity.

Collaborates with Operations Support Services to create monthly metric reports utilizing data from premium billing functions

Serves as SME for core system upgrades

Works with the management team to create updated workflows related to accounts receivable processing

Collaborates with QA on the creation and maintenance of desktop procedures and policies

Assists the management team with audit responses and/or site visits

Participates in departmental and company-wide process improvement projects, training, testing, and team meetings as assigned.

Handles returned mail for the department

Keeps up-to-date productivity records on a daily and monthly basis for corporate and departmental dashboards.

Provides detailed analyses and explanations of all transactions to the Enrollment and Billing Director/Manager and COO as requested


Performs other duties as assigned to meet departmental performance goals and respond to changing priorities, including administrative tasks.

Additional duties may be assigned or requested by the Director or Manager

Qualifications:

Education:
Bachelor's Degree in Accounting or Business, or equivalent experience.

License/Certifications:
N/A

Experience:

Experience:
5 plus years of experience in an office environment, preferably in healthcare and/or managed care systems

Strong financial background related to premium billing

Flexibility in a fast-paced environment.

Excellent organizational skills and time management

Strong focus on quality and performance results

Proficiency in systems including but not limited to MS Excel, MS Word, and MS Access.

Ability to communicate effectively, both written and verbal.

Excellent telephone etiquette.

Strong problem-solving capabilities.

Ability to build relationships and contribute to team performance

Timely response to all audit requests

Adherence to all DOI, state, and federal guidelines

Fallon Health Vaccination Requirements:


To safeguard the health and safety of our workforce, members, and the communities we serve, Fallon Health requires all employees to disclose their COVID-19 vaccination status.

All roles not designated as "Remote" require full COVID-19 vaccination, and Fallon Health will obtain the necessary information from candidates prior to employment to ensure compliance.

Failure to meet the vaccination requirement may result in the rescission of an employment offer or termination of employment.


Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.