Temporary Reconciliation Analyst - MediGold Premium Billing

Trinity Health•Columbus, OH

About The Position

The 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. This role also 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. The analyst is 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). They are responsible for ensuring the eligibility, demographic data, billing and revenue for membership is accurate, and organize, conduct, and monitor the enrollment and billing processes to ensure accurate and timely transactions and revenue from CMS and members. The position 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.

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

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
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