Reconciliation Analyst

This position is temporary/seasonal through April 2027 and is a remote opportunity with a schedule of M-F, 8am-4:30pm EST. Medicare Advantage experience and knowledge of Medicare rules and regulations, specifically around Enrollment and/or sales, would be helpful.

About the Role

The Reconciliation Analyst plans, organizes, conducts, and monitors the enrollment and reconciliation process to ensure the accuracy of Medicare Managed Care membership data and enrollment processing. This includes application and reconciliation of all data and payments from the Centers for Medicare and Medicaid Services (CMS), as well as accurate billing and premium payment reconciliation of the plan's membership.

Organizes, conducts, and monitors all transactions to and from CMS, including the special status tracking process, to ensure accurate reporting and payment from CMS for enrollees who fall into a special payment status category. Prepares and summarizes required reporting for enrollment, disenrollment, billing, and special status to ensure accurate financial reimbursement to the plan.

Responsible for all eligibility and membership functions relating to enrollment, disenrollment, special status, provider attribution, required communications, billing, premiums, revenue, and reconciliation processes for the health plan in accordance with Federal regulatory requirements and CMS. Ensures the eligibility, demographic data, billing, and revenue for membership are accurate. Organizes, conducts, and monitors the enrollment and billing processes to ensure accurate and timely transactions and revenue from CMS and members.

Responsibilities

• Reviews and processes election forms, including all required data elements, and establishes group and member enrollment records, in accordance with department standards, policies, and procedures.
• Assures provision of timely and accurate enrollment information (letters, certificates, Federally required notifications, ID cards, etc.) to members in accordance with Federal requirements and timeframes aligned with department standards, policies, and procedures.
• Receives and 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.
• Audits and reconciles membership data between the enrollment system and other systems and corrects any fallout to ensure accurate membership, claims processing, and health care management.
• Handles sensitive or complex enrollment and disenrollment requests to address customer issues or complaints.

Requirements

• Associates degree in business or related field preferred or equivalent experience required.
• Managed care insurance industry experience required.

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.
• DailyPay – access to earned wages before payday.
• Opportunity to join Diversity, Equity, and Inclusion Colleague Resource Groups.

Schedule

Full-time, day shift (M-F, 8am-4:30pm EST).