Reconciliation and Recovery Analyst

HealthFirst•Lake Mary, FL

1d•$61,300 - $99,620•Remote

About The Position

The Enrollment & Billing (E&B) Reconciliation & Recovery Analyst ensures member data is accurate so eligible Healthfirst members’ premium collection from the State is completed in a timely manner. The incumbent also supports various activities within E&B aimed at minimizing future audit findings by identifying and resolving inconsistencies between Healthfirst, NY State of Health (NYSoH), Department of Health (DOH) and Centers for Medicare & Medicaid Services (CMS).

Requirements

Bachelor’s degree from an accredited institution (or GED/High School diploma from accredited institution with relevant work experience)
Working experience exhibiting strong critical thinking and analytical skills
Familiarity with the data lifecycle within the organization and its impact on the business
Experience working in a team-oriented, collaborative environment
Work experience requiring effective communication verbally and in writing while demonstrating good grammar, spelling, and punctuation skills

Nice To Haves

Degree in Mathematics, Computer Science, Data Sciences, Engineering, Business Analytics, Informatics, or similar concentration
Familiarity with statistical principles, such as standard deviations, normal distributions, and regressions
Familiarity with healthcare data, especially enrollment data
Ability to work effectively with both business and technical stakeholders

Responsibilities

Operate with intellectual curiosity and critically assess existing processes and procedures to identify opportunities for improvement
Summarize and present data outcomes, recommendations, and methodology to Reconciliation and Recovery leadership, E&B leadership, and enterprise stakeholders
Analyze large data sets and identify patterns within the defined population to organize the backlog, determine outliers and identify root-causes of membership, payment, or other data discrepancies
Determine short and long-term actions to resolve current cases of membership/ payment discrepancies and new ones from reoccurring
Understand, validate, and document the business rule(s) to flag membership for reconciliation and/ or premium recovery for a defined population
Liaison between department leaders, subject matter experts, Healthfirst finance, etc.
Establish job-aids to enable user-correction of membership errors and/or submission of information to the DOH and NYSoH
Work with outsourced vendors to enable them to resolve cases flagged for manual correction
Partner with the Quality Assurance (QA) team to develop a QA model to ensure quality, compliance and regulatory standards are met
Work collaboratively across the department and organization to share best-practices and coordinate corrective actions applicable to other populations
Establish tracking mechanism to track effectiveness and data accuracy within the defined population and report results to senior leadership
Other duties as assigned