Revenue Reconciliation Analyst - Medicaid

Centene Corporation • Pittsburgh, PA

2d • $19 - $33 • Hybrid

About The Position

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. This is a hybrid role that requires 2 days a week in the office at location: 48 26th Street, Pittsburgh, PA Position Purpose: 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 or Preferred Education: Bachelor's degree in a related field and may substitute for 2 years' experience in any combination of Reconciliation, Auditing, Accounting or Analytics
• 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.
• 1+ year of experience in government payer system
• Health insurance experience
• Xcyels experience

Responsibilities

• 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.

Benefits

• Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.
• Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status.
• Total compensation may also include additional forms of incentives.
• Benefits may be subject to program eligibility.
• Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
• Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED