Financial Specialist II

Qualifications

• BA/BS degree in accounting, finance or business related field plus four years’ 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. 
• Intermediate knowledge of end-user office software i.e. calendaring, word-processing, spreadsheet and email and the ability to develop a strong proficiency working with a proprietary Health Care system.
• Excellent written and oral communication skills, to include modern business communications, formatting of professional letters, reports and phone etiquette.
• Customer service oriented.
• Ability to analyze and resolve technical problems and/or client inquiries as they arise.
• Cross train on Eligibility processing handling that portion of the business as necessary.
• 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 and standard health care eligibility provisions.
• 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 4 business days of account funding.
• Manage the process of funding and releasing self-funded claims payments.
• Perform the preparation and completion of schedule “A” and Tax form 5500.
• Month End Financials completed and delivered to Accounting by the fifth (5^th) business day of the month.
• Manage and maintain Bank of America lockbox, and ACH/Wire programs.
• Manage and maintain retiree invoicing & receivable management program(s).
• Maintain FSA (Flexible Spending Account) program.  

• Process and verify the necessary corrections on manual adjustments posted to group ledger on HealthCare Processing System for PCMI, Western Growers Assurance Trust (WGAT) and individual accounts (COBRA).
• 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 staff financial duties.
• Process related written and verbal account inquiries to its conclusion in a timely manner to include research on as needed basis.
• Identify inefficiencies within the established processes and suggest possible solutions to save time, reduce risk, and/or reduce expenses.
• Create and document a minimum of one new Standard Operating Procedure (SOP) annually.
• Identify, initiate and implement at least one process improvement and/or innovation annually. 

• Work with Eligibility Specialists to research/resolve unpaid and/or outstanding balances for PCMI employer groups, and COBRA accounts.
• Serve as representative of PCMI displaying professionalism, knowledge, customer service and discretion in all interactions with other members of PCMI 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 actually helping assess and report performance in terms of impact, making improvements, and course correcting along the way.

• 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.