NHS Human Services, Inc.

The Benefits Billing Recon and Eligibility team is responsible for a number of operational tasks for ADP Totalsource. The department’s responsibilities include client billing, carrier payments and the associated reconciliation and adjustment processes, equaling $3 billion per year. In addition to these tasks, the team serves as the first line of communication for Totalsource’s carrier partners, the internal service teams, and the accounting department. Another main area of focus is the transferring of accurate and timely eligibility information between ADP systems and our carrier partner systems. Eligibility related responsibilities include the administration of the Electronic Data Interface process and the research/management of eligibility discrepancy reports. Members on the team are responsible for proactively identifying issues to internal processes and vetting out solutions to maximize efficiencies and minimize risks.

• Carrier Reconciliation & Payment: Conduct monthly carrier reconciliations of assigned carriers. Average monthly carrier payments valued at $3 billion on an annualized basis. Monitor carrier activity to ensure that reconciliation files are received or sent on a timely basis. Perform eligibility data reconciliation. Create, maintain and modify queries needed to reconcile eligibility data. Create error files to send to regions and/or carriers. Research error files. If carrier system access is available, terminate all identified terminations that have appeared as a discrepancy. Maintain reconciliation files. When dealing with Paid as Billed carriers, incorporate and manage the Net Zero reconciliation process.

• Client Billing: Ensure Client Benefit Billing processes are completed timely and accurately as well as prepare and deliver monthly ACH file. Average monthly client billing is valued at $250 million. Identify and communicate billing errors to carriers and internal partners. Ensure all recon and corrections have been made prior to the subsequent billing runs. Oversee the timely and correct auditing of benefit adjustments. Prepare monthly billing reconciliation files and journal entry worksheets. Prepare files and reports needed for reclassification of expenses.

• WSE Eligibility: Manage eligibility communications between carriers and internal partners. Assist benefit service team with diagnosing and solving eligibility issues. Run the weekly EDI process and resolve any transmission failures. Actively work and manage the discrepancy report reconciliation process between processes. Monitor the workflow of electronic eligibility interfaces from creation to carrier receipt.

• Field Support & Training: Acts as the liaison between Benefits Billing & Reconciliation and the service teams for billing and adjustment related questions. Train new associates and cross train team members to ensure the proper backups are in place for each department function.

• Process Improvement: Leads technology projects to automate systems and improve processes. Troubleshoots and resolves problems, explores opportunities for enhancements and improvements to existing Client-related benefit billing reports, and financial reporting tools.

• Bachelor’s Degree (or equivalent in education and experience) Preferred

• Microsoft Office proficiency with focus on Excel

• 1-2 years of directly related experience. Prior experience related to data analysis and information management of large sets of data are preferred. Also relevant are roles related to Accounting and Finance.

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