Reconciliation Analyst

This position is temporary/seasonal through April 2027 and is a remote opportunity with a schedule of Monday through Friday, 8:00 AM – 4:30 PM EST.

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. The role involves managing transactions to and from CMS, including special status tracking, to ensure accurate reporting and payment for enrollees in special payment status categories. The analyst prepares and summarizes required reporting for enrollment, disenrollment, billing, and special status to ensure accurate financial reimbursement to the plan. Responsibilities also include all eligibility and membership functions related to enrollment, disenrollment, special status, provider attribution, required communications, billing, premiums, revenue, and reconciliation processes in accordance with federal regulatory requirements and CMS guidelines.

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.
• Ensures provision of timely and accurate enrollment information (letters, certificates, federally required notifications, ID cards, etc.) to members in accordance with federal requirements and departmental timeframes.
• Receives and reconciles CMS transaction reply reports against the membership files of the health plan to ensure accuracy and compliance with federal requirements.
• Audits and reconciles membership data between the enrollment system and other systems, correcting any discrepancies to ensure accurate membership, claims processing, and healthcare management.
• Handles sensitive or complex enrollment and disenrollment requests to address customer issues or complaints.

Requirements

• Associate’s degree in business or a related field preferred, or equivalent experience required.
• Managed care insurance industry experience required.
• Medicare Advantage experience and knowledge of Medicare rules and regulations, specifically around enrollment and/or sales, is helpful.

Benefits

• Competitive compensation and benefits packages, including medical, dental, and vision coverage starting on day one.
• Retirement savings account with employer match starting on day one.
• Generous paid time off programs.
• Employee recognition programs.
• Tuition and professional development reimbursement starting on day one.
• 100% paid RN to BSN tuition at Mount Carmel’s College of Nursing.
• Relocation assistance (geographic and position restrictions apply).
• Employee Referral Rewards program.
• Access to DailyPay, allowing you to see daily earnings and transfer funds before payday.
• Opportunity to join Diversity, Equity, and Inclusion Colleague Resource Groups.

Schedule

Full-time, day shift: Monday through Friday, 8:00 AM – 4:30 PM EST.