Membership Reconciliation Analyst - Hybrid/Medicaid

Centene Management Company•Pittsburgh, PA

17h•Hybrid

About The Position

With the PA Health and Wellness Medicaid reconciliations team, this role supports initiatives by conducting targeted outreach and screening to members via telephone for healthcare alignment opportunities, educating members, and facilitating seamless referrals to drive enrollment and improve overall member outcomes. Conduct 30-to-60-day outreaches to participants to ensure they have completed or are in the process of completing their redetermination packets for the state. Outreach participants to assess participant interest in dual alignment and route qualified referrals to the Medicare Advantage team, ensuring timely follow-up and continuity of care coordination. Reconcile enrollment and revenue data between internal systems and external sources (e.g., state systems). Analyze and validate 834 enrollment data and 820 payment data to ensure accuracy. Collaborate with cross-functional teams to correct data inconsistencies. Maintain accurate documentation and reconciliation processes, findings, and resolutions.

Requirements

High School or GED
2+ years of experience in any combination of Reconciliation, Auditing, Accounting or Analytics

Nice To Haves

Strong customer service and member engagement skills, with the ability to build trust and communicate complex healthcare information clearly.
Knowledge of Medicaid, Medicare, and dual eligibility.
Ability to educate participants on plan benefits and guide them through decision making without being sales driven.
Excellent communication skills (Phone, email, and documentation) with professional and empathetic approach.
Experience handling high volume outreach calls.
Basic analytical skills to review member data.
Ability to manage time effectively, meet performance metrics, and follow structured workflows.
Bachelor's degree in a related field and may substitute for 2 years' experience in any combination of Reconciliation, Auditing, Accounting or Analytics
1+ year of experience in government payer system
Health insurance experience
Xcyels experience

Responsibilities

Conduct targeted outreach and screening to members via telephone for healthcare alignment opportunities.
Educate members and facilitate seamless referrals to drive enrollment and improve overall member outcomes.
Conduct 30-to-60-day outreaches to participants to ensure they have completed or are in the process of completing their redetermination packets for the state.
Outreach participants to assess participant interest in dual alignment and route qualified referrals to the Medicare Advantage team.
Reconcile enrollment and revenue data between internal systems and external sources (e.g., state systems).
Analyze and validate 834 enrollment data and 820 payment data to ensure accuracy.
Collaborate with cross-functional teams to correct data inconsistencies.
Maintain accurate documentation and reconciliation processes, findings, and resolutions.