Reconciliation Analyst - MediGold - Seasonal/Temp

Trinity Health Corporation • Columbus, OH

41d

About The Position

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

• Education: Associates degree in business or related field preferred or equivalent experience required.
• Experience: 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.

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.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Religious, Grantmaking, Civic, Professional, and Similar Organizations
• Education Level: Associate degree
• Number of Employees: 5,001-10,000 employees