Qureos Mentor

Brighton Health Plan Solutions

<div>About the Role 
BHPS has a great opportunity for a Senior Accountant to join the Finance Team. Reporting to the Finance Manager, the Senior Accountant will be responsible for day-to-day accounting transactions and assisting with the financial close process, including performing analysis and reconciliations, as well as other ad hoc accounting requests. 
 
Position is a hybrid role whereby some days will be remote, while other days will be in the office. 
The Senior Accountant has functional responsibility over certain accounting/financial elements of service delivery for our Expanded TPA clientele. 
 
Primary Responsibilities<ul><li>
Execute on specific financial processes in support of Contribution Accounting and Financial Administration to ensure financial operations are in compliance with client needs and expectations, including:<ul><li>
Perform data feed reconciliations to ensure complete and accurate transfer of important client data.</li><li>
Ensure system generated invoices are released on schedule.</li><li>
Partner with the Account Payable function to ensure Insurance Carriers and Vendor Partner payments are made accurately and timely.</li><li>
Prepare ACHs for Insurance Carriers and Care providers.</li><li>
Responsible for coding and posting AP invoices and researching any discrepancies.</li><li>
Prepare and process payments for Premium and Self pays.</li><li>
Work with bank to upload ACHs, resolve any kick outs and download checks that have cleared. Responsible for daily cash management/cash reviews. Perform payment reconciliations to invoicing to identify under/over payments.</li><li>
Analyze, monitor and prepare general ledger account analysis.</li><li>
Follow up with Payroll providers unpaid invoices, as needed.</li><li>
Prepare journal entries.</li><li>
Participate in month end close, including preparing general ledger account analysis, monthly bank reconciliations and other ad hoc analysis.</li></ul></li><li>
Work across teams within the company and with our client.</li><li>
Partner with our Enrollment &amp; Eligibility team to help address questions from Caregivers.</li><li>
Build and maintain strong relationships with Payroll Partners, Insurance Carriers and Vendor partners to facilitate resolution of all matters regarding cash receipts and payments.</li><li>
Detail-oriented and able to spot errors and discrepancies in financial data quickly and accurately.</li><li>
Communicate and escalate all problems and challenges timely to the Finance Manager.</li><li>
Assist with annual external audits by preparing schedules.</li></ul>
Essential Qualifications<ul><li>
Bachelor&rsquo;s degree in accounting or finance required.</li><li>
3-5 years of accounting experience.</li><li>
Have a keen eye for detail and the desire to probe further into data as necessary.</li><li>
Be well organized and follow through on deadlines.</li><li>
Excel user and confident with VLOOKUP, INDEX/MATCH, SUMIFS formulas.</li><li>
Exceptional team player with the confidence and integrity to earn client partners&rsquo; and internal team confidence quickly.</li><li>
Excellent communication skills required, including written, verbal and interpersonal.</li><li>
Strong familiarity with Microsoft Dynamics AX and Management Reporter preferred.</li></ul>
About
At Brighton Health Plan Solutions, LLC, our people are committed to the improvement of how healthcare is accessed and delivered. When you join our team, you&rsquo;ll become part of a diverse and welcoming culture focused on encouragement, respect and increasing diversity, inclusion and a sense of belonging at every level. Here, you&rsquo;ll be encouraged to bring your authentic self to work with all of your unique abilities.
Brighton Health Plan Solutions partners with self-insured employers, Taft-Hartley Trusts, health systems, providers as well as other TPAs, and enables them to solve the problems facing today&rsquo;s healthcare with our flexible and cutting-edge third-party administration services. Our unique perspective stems from decades of health plan management expertise, our proprietary provider networks, and innovative technology platform. As a healthcare enablement company, we unlock opportunities that provide clients with the customizable tools they need to enhance the member experience, improve health outcomes and achieve their healthcare goals and objectives. Together with our trusted partners, we are transforming the health plan experience with the promise of turning today&rsquo;s challenges into tomorrow&rsquo;s solutions.
Come be a part of the Brightest Ideas in Healthcare&trade;.
Company Mission
Transform the health plan experience &ndash; how health care is accessed and delivered &ndash; by bringing outstanding products and services to our partners.
Company Vision
Redefine health care quality and value by aligning the incentives of our partners in powerful and unique ways. 
 
JOB ALERT FRAUD: We have become aware of scams from individuals, organizations, and internet sites claiming to represent Brighton Health Plan Solutions in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All of our career opportunities are regularly published and updated brighonthps.com Careers section. If you have already provided your personal information, please report it to your local authorities. Any fraudulent activity should be reported to: recruiting@brightonhps.com 

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Senior Accountant

<div>
 
 About The Role
 
 
 
 BHPS provides Utilization Management services to its clients. The Utilization Management Nurse performs medical necessity and benefit review requests in accordance with national standards, contractual requirements, and a member&rsquo;s benefit coverage while working remotely.
 
 
 
 Primary Responsibilities
 
 
 
 <ul>
 <li>
 Performs clinical utilization reviews using evidenced based guidelines, policies and nationally recognized clinical criteria and internal policies/procedures
 </li>
 <li>
 Identifies potential Third-Party Liability and Coordination of Benefit Cases and notifies appropriate parties/departments
 </li>
 <li>
 Collaborates with healthcare partners to ensure timely review of services and care
 </li>
 <li>
 Provides referrals to Case management, Disease Management, Appeals &amp; Grievances, and Quality Departments as needed
 </li>
 <li>
 Develop and review member centered documentation and correspondence reflecting determinations in compliance with regulatory and accreditation standards
 </li>
 <li>
 Identifies potential quality of care issues, service or treatment delays and intervenes as clinically appropriate
 </li>
 <li>
 Triages and prioritizes cases and other assigned duties to meet required turnaround times
 </li>
 <li>
 Prepares and presents cases to Medical Director (MD) for medical director oversight and necessity determinations
 </li>
 <li>
 Communicates determinations to providers and/or members in compliance with regulatory and accreditation requirements
 </li>
 <li>
 Duties as assigned
 
 
 </li>
 </ul>
 
 Essential Qualifications
 
 
 
 <ul>
 <li>
 Current Licensed Practical Nurse (LPN) with state licensure. Must retain active and unrestricted licensure throughout employment
 </li>
 <li>
 Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint)
 </li>
 <li>
 Must be able to work independently
 </li>
 <li>
 Must be detail oriented and have strong organizational and time management skills
 </li>
 <li>
 Adaptive to a high pace and changing environment- flexibility in assignment
 </li>
 <li>
 Proficient in Utilization Review process including benefit interpretation, contract language, medical and policy review
 </li>
 <li>
 Proficient in MCG and CMS criteria sets
 </li>
 <li>
 Experience with both inpatient and outpatient reviews including Behavioral Health, DME, Genetic Testing, Clinical Trials, Oncology, and/or elective surgical cases preferred
 </li>
 <li>
 Working knowledge of URAC and NCQA
 </li>
 <li>
 2+ years&rsquo; experience in a UM team within managed care setting
 </li>
 <li>
 3+ years&rsquo; experience in clinical nurse setting preferred
 </li>
 <li>
 TPA Experience preferred
 
 
 </li>
 </ul>
 
 About
 
 
 
 At Brighton Health Plan Solutions, LLC, our people are committed to the improvement of how healthcare is accessed and delivered. When you join our team, you&rsquo;ll become part of a diverse and welcoming culture focused on encouragement, respect and increasing diversity, inclusion and a sense of belonging at every level. Here, you&rsquo;ll be encouraged to bring your authentic self to work with all of your unique abilities.
 
 
 Brighton Health Plan Solutions partners with self-insured employers, Taft-Hartley Trusts, health systems, providers as well as other TPAs, and enables them to solve the problems facing today&rsquo;s healthcare with our flexible and cutting-edge third-party administration services. Our unique perspective stems from decades of health plan management expertise, our proprietary provider networks, and innovative technology platform. As a healthcare enablement company, we unlock opportunities that provide clients with the customizable tools they need to enhance the member experience, improve health outcomes and achieve their healthcare goals and objectives. Together with our trusted partners, we are transforming the health plan experience with the promise of turning today&rsquo;s challenges into tomorrow&rsquo;s solutions.
 
 
 Come be a part of the Brightest Ideas in Healthcare&trade;.
 
 
 
 Company Mission
 
 
 
 Transform the health plan experience &ndash; how health care is accessed and delivered &ndash; by bringing outstanding products and services to our partners.
 
 
 
 Company Vision
 
 
 
 Redefine health care quality and value by aligning the incentives of our partners in powerful and unique ways.
 
 
 Powered by JazzHR
 
 
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</div>

Utilization Management Nurse

Join Brighton Health Plan Solutions and explore 2   exciting career opportunities. They're hiring for various roles with options for remote or on-site work. Apply today and become part of their innovative team.

Brighton Health Plan Solutions

About Company

Senior Accountant

Utilization Management Nurse