Enrollment & Reconciliation Specialist

Alohacare; Honolulu (HI); Presencial; USD 23.000 - 30.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Health insurance

Paid time off

401k plan

Vision insurance

Descripción de la vacante

AlohaCare is seeking an Enrollment Reconciliation Specialist in Hawaii to oversee Medicare D-SNP enrollment reconciliation and CMS/MARx transactions. You will coordinate with internal teams and CMS to ensure data accuracy across systems, resolving complex discrepancies that affect member eligibility and claims.

The role requires advanced Excel and data-reconciliation skills, and experience with CMS processes and audits.

Formación

• Experience with CMS/MARx enrollment processes.
• Experience handling CMS 834 transactions and retroactive enrollment processing.
• Experience supporting CMS audits and regulatory requirements.

Responsabilidades

• Research root causes of enrollment discrepancies and develop corrective actions.
• Manage reinstatements and retroactive enrollment changes through resolution.
• Reconcile Medicare D-SNP enrollment with Medicaid/QUEST eligibility.
• Validate enrollment changes and their downstream impact on claims and benefits.
• Maintain reconciliation tracker, issue logs, and management reporting.
• Provide guidance to enrollment staff on complex reconciliation issues.
• Develop reporting showing enrollment status, discrepancies, and resolution progress.

Conocimientos

Advanced Excel

Data reconciliation

CMS/MARx knowledge

Analytical thinking

Time management

Herramientas

MS Word

MS Excel

MS Access

Outlook

PowerPoint

Descripción del empleo

AlohaCare’s leadership empowers and engages its employees by recognizing outstanding job performance and collaboration. We share organization-wide updates during quarterly All Staff meetings. We encourage participation in volunteer and educational opportunities. We put a high value on honesty, respect, and trust-building. We encourage open-door, two-way, and frequent communication.

AlohaCare’s comprehensive benefits package includes low-cost medical, dental, drug and vision insurance, paid time-off, 401k employer contribution, referral bonus and pretax transportation and parking program.

The Opportunity:

The Enrollment Reconciliation Specialist provides advanced operational oversight of Medicare D-SNP enrollment reconciliation and CMS/MARx transactions. This role is responsible for identifying, researching, and resolving complex enrollment discrepancies that may impact member eligibility, claims, pharmacy, accumulations, and regulatory reporting.

The position serves as a subject matter resource to Enrollment and Plan Operations, coordinating with internal departments, CMS and other stakeholders to ensure enrollment data is accurate, timely, and fully reconciled across systems.

• Research root causes of enrollment discrepancies and develop appropriate corrective actions.
• Manage and track member reinstatements, retroactive enrollment changes, and CMS transaction corrections through resolution.
• Reconcile Medicare D-SNP enrollment with applicable Medicaid/QUEST eligibility and identify issues affecting member eligibility.
• Validate enrollment changes and their downstream impact on claims, pharmacy, member benefits, accumulations and other operational systems.
• Maintain detailed reconciliation tracker, issue logs, audit documentation, and management reporting.
• Identity trends and recurring issues and perform root cause analysis and process improvement.
• Provide guidance and subject matter expertise to enrollment staff on complex reconciliation issues and CMS transactions.
• Develop and maintain reporting that provides leadership with visibility into enrollment status, outstanding discrepancies, transaction activity, risk, and resolution progress.
• Escalate significant enrollment issues and potential members or financial impacts to leadership.
• All other duties assigned.
• Adhere to regulatory compliance and quality guidelines as well as AlohaCare policies and procedures.
• Responsible for maintaining AlohaCare’s confidential information in accordance with AlohaCare policies, and state and federal laws, rules and regulations regarding confidentiality. Employees have access to AlohaCare data based on the data classification assigned to this job title.
• Strong knowledge of CMS/MARx enrollment processes.
• Experience working with Medicare Advantage and preferably D-SNP/Medicaid populations.
• Advanced Excel and data-reconciliation skills
• Demonstrated ability to independently research complex enrollment issues and determine appropriate resolution.
• Achieves results, builds trust, communicate effectively, customer and quality focused.
• Able to work independently with minimal supervision.
• Able to effectively work in a fast-paced and changing environment, manage multiple projects and priorities across multiple teams/projects and in a matrixed environment.
• Possesses excellent time management and organizational skills; is dependable, enthusiastic, self-starting, and self-motivated. Uses time effectively, reacts professionally under pressure.
• Data entry experience with a high degree of accuracy and attention to detail.
• Intermediate skills in Microsoft Programs: Word, Excel or Access Databases, Outlook and PowerPoint.
• Available to work a flexible schedule, including weekends and holidays, when necessary.

Preferred Requirements:

• Experience with CMS 834 transaction and MARx and RPC processing
• Experience with retroactive enrollment, disenrollment, and reinstatement processing.
• Experience with Medicaid/QUEST or integrated Medicare/Medicaid programs.
• Experience supporting CMS audits and regulatory requirements.
• Experience developing reconciliation processes, controls and reporting.
• May require prolonged sitting- up to 4 hours.
• Requires prolonged operation of a computer workstation, including the ability to type for extended periods of time on a keyboard during the scheduled workday.

Salary Range: $17.00 - $22.00 an hour

AlohaCare is committed to providing equal employment opportunity to all applicants in accordance with sound practices and federal and state laws. Our policy prohibits discrimination and harassment because of race, color, religion, sex (including gender identity or expression), pregnancy, age, national origin, ancestry, marital status, arrest and court record, disability, genetic information, sexual orientation, domestic or sexual violence victim status, credit history, citizenship status, military/veteran status, or other characteristics protected under applicable state and federal laws, regulations, and/or executive orders.