Senior Reconciliation & Recovery Analyst

HF Management Services•Greenwood, FL

6d•Remote

About The Position

The Enrollment & Billing (E&B) Senior 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) and Department of Health (DOH).

Requirements

Bachelor’s degree from an accredited institution
Working experience exhibiting strong critical thinking and analytical skills
Familiarity with writing SQL queries for the purpose of analyzing data and establishing business rules and requirements
Familiarity with relational database structures, theories, principles, and practices
Familiarity with data models and/or data modelling
Ability to understand the data lifecycle within the organization and its impact on the business
Experience working in a team-oriented, collaborative environment
Ability to communicate effectively verbally and in writing while demonstrating good grammar, spelling, and punctuation skills
Ability to work effectively with both business and technical stakeholders
Work experience requiring meticulous attention to detail

Nice To Haves

Degree in Mathematics, Computer Science, Data Sciences, Engineering, Business Analytics, Informatics, or similar concentration
Experience with Alteryx, Tableau, Amazon Redshift, or other similar tools/platforms
Familiarity with statistical principles, such as standard deviations, normal distributions, and regressions
Familiarity with healthcare data, especially enrollment data

Responsibilities

Operate with intellectual curiosity and critically assess existing processes and procedures to identify opportunities for improvement
Develop complex analyses requiring the integration of multiple data sources, evaluation of data quality, and standardization of data to consistent format/structure
Create advanced queries and reports that extract data to support business teams’ needs, including working with nesting tables and temp tables and writing multiple conditions against varying data sets
Summarize and present data outcomes, recommendations, and methodology to Reconciliation and Recovery leadership, E&B leadership, and enterprise stakeholders
Create and run routine reporting to monitor the enrollment activities of a defined population and ensure data accuracy
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.
Develop strategy and potential solutions to resolve membership discrepancies within the defined population
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 or requested