Reconciliation Analyst - MediGold

Trinity Health•Columbus, OH

16h

About The Position

MediGold is a not-for-profit Medicare Advantage insurance plan serving seniors and other Medicare beneficiaries across the United States. We’re dedicated to providing excellent customer service, cost-effective care, and exceptional healthcare coverage. We rely on talented colleagues in a wide variety of professional roles including information technology, financial analysis, audit, provider relations and more. Reconciliation Analyst plans, organizes, conducts and monitors the enrollment and reconciliation process to ensure accurate membership processing, application and reconciliation of all data and payments from CMS as well as accurate billing and premium payment reconciliation of the plan's membership Organizes, conducts and monitors the special status tracking process to ensure accurate reporting and payment from CMS for enrollees who fall into a special payment status category. Responsible for all eligibility and membership functions relating to enrollment, disenrollment, special status, billing, premiums, revenue and reconciliation processes for the health plan in accordance with Federal regulatory requirements and the Centers for Medicare and Medicaid Services (CMS). Responsible for ensuring the eligibility, demographic data, billing and revenue for membership is accurate. Organizes, conducts, and monitors the enrollment and billing processes to ensure accurate and timely transactions and revenue from CMS and members

Requirements

Associates degree in business or related field preferred or equivalent experience required.
Managed care insurance industry experience required.
Able to apply regulations to work processes.
Proven ability to successfully work with internal and external groups to accomplish reconciliation of payment reports and activities.
Proven skill and ability to track and report financial and statistical data.
Knowledge of computer systems including Microsoft Office.
Service-oriented individual with an ability to effectively resolve customer issues.
Analytical and problem solving skills.

Nice To Haves

Associates degree in business or related field

Responsibilities

Assures provision of timely and accurate enrollment information (letters, certificates, Member Agreement, handbooks, ID cards, etc.) to members, in accordance with department standards, policies and procedures.
Reconciles the CMS transaction reply reports against the membership files of the health plan in accordance with department standards, policies, and procedures to ensure accuracy and meet Federal requirements.
Maintains current knowledge of CMS regulations related to enrollment, disenrollment, billing, and special statuses.
Compile information and documentation to support special status payment requests to governmental agencies.
Respond to written and verbal requests for information from federal and local Government agencies such as CMS, or state department of insurance.
Monitors and effectuates membership and financial transactions including payment posting, reconciliation, electronic funds transfer posting and maintenance, late letter process, processing of returned payments, billing statements, evaluation and completion of required reporting.
Willingness to learn and comprehend various aspects of Plan and identify engagement opportunities and integration points.

Benefits

Competitive compensation and benefits packages including medical, dental, and vision with coverage starting on day one.
Retirement savings account with employer match starting on day one.
Generous paid time off programs.
Employee recognition programs.
Tuition/professional development reimbursement starting on day one.
RN to BSN tuition 100% paid at Mount Carmel’s College of Nursing.
Relocation assistance (geographic and position restrictions apply).
Employee Referral Rewards program.
Mount Carmel offers DailyPay - if you’re hired as an eligible colleague, you’ll be able to see how much you’ve made every day and transfer your money any time before payday.
Opportunity to join Diversity, Equity, and Inclusion Colleague Resource Groups.