Finance Operations is responsible for multiple time sensitive financial operations and claims related payment processes across all lines of business. This includes reconciliation, validation, and release of weekly provider payments exceeding $50 million, bi weekly Rx payment reconciliation, and filing of several monthly assessments in accordance with State regulations.as In addition it includes the reconciliation and processing of complex vendor payments and preparing reconciliations and reporting for all Finance Operations processes as needed. Under the direction of the Supervisor of Finance Operations this position will be responsible for coordinating that all weekly, monthly, and annual tasks are completed accurately and timely. The position requires the ability to problem solve, multitask, and work in a deadline driven environment with multiple systems.
KEY RESPONSIBILITIES/ESSENTIAL FUNCTIONS* (in order of importance)
* Responsible for coordinating with the finance operations specialist to ensure the timely and accurate completion of all claim-related payment processes for all Tufts Health Plan business lines (Commercial, Senior Products, and Public Plans) in accordance with corporate policies and compliance requirements. This includes validation, reconciliation, and release of both check/EFT payments for all claims related weekly and monthly medical check runs, including the bi-weekly pharmacy claims payments. This also includes monitoring and processing transactions online with the Bank and reviewing stop and void payment batches. Responsible for assisting in working with IT, payment vendor and appropriate business owners to ensure all required claims payment processing information is accurate and all production issues are promptly resolved.
* Responsible for completing all reconciliations and reporting related to all Finance Operations processes in a timely and accurate manner. This includes completing the monthly outstanding check and EFT bank reconciliations for all claims accounts, void payment reconciliations, refund and recovery reconciliations, pharmacy payment reconciliations, CareLink SPP reconciliation, and processing of the CareLink Shared Admin invoicing. Responsible for assisting in the resolution of all GL reconciliation items related to claims payments.
* Responsible for processing all claims related regulatory payments in accordance with state and federal requirements in a timely and accurate manner. This includes validating and processing payments for all state assessments, including filing submissions for MA HSN and NYHCRA . Assist Supervisor in working with appropriate business areas to implement all new assessments or regulation changes to the Finance Operations payment processes. This also includes the annual reconciliation and processing of 1099 Misc, 1099 corrections and B-notices for all business lines, as well as completing the annual escheating process and Abandoned Property filing. Expected to respond to inquiries as needed.
* Responsible for coordinating with the finance operations specialist to ensure all claims related vendor payments are completed in a timely and accurate manner in accordance with the contracts and corporate policies. This includes ensuring all vendor payment invoice reporting is received in a timely and accurate manner to ensure timely processing. Assist Supervisor in working with appropriate business areas to implement all new vendor payments and respond to inquiries.
* Responsible for coordinating with Finance Operations Specialist and Coordinator on the timely and accurate processing of all unapplied cash receipts (UCR), as well as have an understanding of process completion for miscellaneous cash receipts and customer service requests.. Assist in reviewing all miscellaneous cash deposit and UCR deposit batches for accuracy. Work with Supervisor to complete the monthly UCR reconciliation and assist in maintenance to UCR system and reporting.
* Gain knowledge and understanding of all processes to be subject matter expert for Finance Operations team. Participate in projects by assisting with business requirements, UAT testing, and processes feedback. Provide cross team support with Client Funding team on third party payments, GL reconciliations, funding check run, and monthly processes. Learn and perform processes in order to provide back up to Funding team as needed and gain full view of Finance Operations processes to best support all lines of business.
Other duties and projects as required
* Assist other Finance Operations teams as needed
* Ensure that all department policies and procedures are maintained and followed.
* Participate in gathering information and respond to Finance Operations internal and external audit requests.