Position Purpose: 

In accordance with the Mission, Core Values and Vision; 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, 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 ensuring 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). 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. 

What You Will Do: 

• 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. 

Minimum Qualifications: 

• Education:  Associates degree in business or related field preferred or equivalent experience required.  

• Experience: Managed care insurance industry experience required.