Medicare Enrollment Reconciliation Analyst

Verda Healthcare Inc; Huntington Beach (CA); On-site; USD 32,000 - 40,000; Full time

Benefits offered by this job

Health insurance

401(k)

PTO

Dental Insurance

Vision insurance

Life insurance

Job summary

Verda Healthcare, Inc. is seeking a Medicare Enrollment Reconciliation Analyst to join our team in Huntington Beach, CA.

You will reconcile the CMS Monthly Membership Report and TRR to enrollment data, identify variances, conduct root-cause analysis, and ensure accurate government payments to recognize revenue. You will report to the Enrollment Director and collaborate with CMS vendors, manage data entry, produce management reports, and support monthly closings to uphold compliance and data

Qualifications

• Bachelor's degree in a related field; equivalent education or experience may be considered in lieu of degree.
• 3-5 years of experience in Medicare/Medi-Cal eligibility processing in a health plan setting.
• Experience with data reconciliation, enrollment processing, or related field beneficial.
• Experience with CMS vendors (RPC, ECRS, MARx) preferred.

Responsibilities

• Reconcile CMS enrollment data (MMR and TRR) to membership data.
• Analyze discrepancies, perform root-cause analysis, and escalate accordingly.
• Track and document variances across IPA, county, age, gender, plan benefit, etc.
• Generate reports to monitor enrollment data and identify trends or issues.
• Ensure accurate and timely entry of enrollment data into systems.
• Support monthly closings and policy development related to enrollment processes.

Skills

Project management

Analytical skills

Communication skills

Independent work

Prioritization

Education

Bachelor's degree in related field

Tools

Excel

MS Access

SQL

Job description

Description

Verda Healthcare, Inc. is a Medicare Advantage Prescriptions Drug Plan (MAPD) organization committed to the idea that healthcare should be easily and equitably accessed by all, currently available in Texas and Arizona. Our mission is to ensure that underserved communities have access to health and wellness services, and receive the support needed to live a healthy life that is free of worry and full of joy. We are looking for a Medicare Enrollment Reconciliation Analyst to join our growing company with many internal opportunities.

Are you ready to join a company that is changing the face of health care across the nation? Verda Healthcare, Inc. is looking for people like you who value excellence, integrity, care and innovation. As an employee, you’ll join a team dedicated to improving the lives of our Medicare members. Our vision incorporates value-based health care that works. We value diversity.

Align your career goals with Verda Healthcare, Inc. and we will support you all the way.

Position Overview

The Medicare Enrollment Reconciliation Analyst is responsible for reconciling the monthly CMS - Monthly Membership Report (MMR) and Transaction Reply Report (TRR) - to membership data. This reconciliation process is crucial to enrollment being correct and accounted for as well as ensuring payment from the government is complete and accurate to recognize revenue appropriately. This position identifies variances, performs root-cause analysis and escalates to appropriate parties for decision making. The expectation is timely explanation and remediation of any errors.

This position will work report directly to the Enrollment Director.

Responsibilities:

• Analyze and audit enrollment transactions received from CMS.
• Review statistics to measure, audit and analyze identified discrepancies with trend and management reports.
• Compare and reconcile enrollment data from different sources to identify discrepancies.
• Generate and analyze reports to track enrollment data and identify trends or issues
• Ensure accurate and timely entry of enrollment data into systems
• Reconcile member membership eligibility received from CMS.
• Accurately track membership enrollment by IPA, county, age, gender, plan benefit, etc.
• Assists management with reports, reconciliations, and monthly closings.
• Complete Electronic Data Validation within the CMS timeframes.
• Conduct Premium Billing research and perform quality assurance to ensure accuracy of invoices going out.
• Ensure Enrollment and Disenrollment compliance with the Center of Medicare Services (CMS)
• Ensure accurate and timely processing of enrollment file processing (whether automated or manual) and CMS transaction reply to reports for Verda's Medicare program(s). As part of the CMS file processing, ensure regulatory response transactions are sent to CMS timely along with required member correspondence sent to members.
• Thoroughly document inconsistencies/issues/concerns for follow-up and/or resolution by internal support staff or the software vendor.
• Track the status of assigned tasks and/or related problem issues for completion.
• Aid in the development and maintenance of policies and procedures related to job functions, application configuration, general usage of supported systems and application maintenance.
• Perform other duties as assigned.

Minimum Qualifications

• Bachelor's degree in a related field; equivalent education or experience may be considered in lieu of degree.
• At least 3-5 years of experience in Medicare and/or Medi-Cal eligibility processing required particularly in a health plan setting with demonstrated experience on the following list of stated knowledge, experience and/or skills.
• Previous experience in data reconciliation, enrollment processing or a related field is beneficial.
• Experience working with CMS contracted vendors (for example Processing Contractor (RPC), ECRS or MARx) preferred.

Professional Competencies

• Strong project management, analytical, and problem-solving skills.
• Solid communication skills, oral and written.
• Must have advanced skills in Excel in order to ingest and parse data.
• Must have advanced PC skills (MS Office, Word, Access), etc.
• Strong ability to accept responsibility and work independently.
• Prefer working knowledge of relational database systems like SQL and MS Access.
• Ability to prioritize multiple projects without compromising desired timelines.
• Strong Healthcare industry knowledge preferred.
• Knowledge of Managed Care systems and client/server applications preferred.

Verda cares deeply about the future, growth, and well-being of its employees. Join our team today!

Job Type: Full-time employment Location: Huntington Beach, CA

Compensation Range:

$23 - $29 hourly

Actual compensation offered will be determined based on experience, qualifications, skills, internal equity (if available), and geographic location. This position may also be eligible for performance-based incentive compensation and benefits.

Benefits:

• 401(k)
• Paid time off (vacation, holiday, sick leave)
• Health insurance
• Dental Insurance
• Vision insurance
• Life insurance

Schedule:

• Full-time onsite (100% in-office)
• Hours of operations: 9am - 6pm
• Standard business hours Monday to Friday/weekends as needed
• Occasional travel may be required for meetings and training sessions.

Ability to commute/relocate:

• Reliably commute or planning to relocate before starting work (Required)

PHYSICAL DEMANDS

Regularly sit/walk at a workstation in an office or cubicle setting. Must occasionally lift and/or move up to 25-50 pounds.

*Other duties may be assigned in support of departmental goals.

Requirements

Minimum Qualifications

• Bachelor's degree in a related field; equivalent education or experience may be considered in lieu of degree.
• At least 3-5 years of experience in Medicare and/or Medi-Cal eligibility processing required particularly in a health plan setting with demonstrated experience on the following list of stated knowledge, experience and/or skills.
• Previous experience in data reconciliation, enrollment processing or a related field is beneficial.
• Experience working with CMS contracted vendors (for example Processing Contractor (RPC), ECRS or MARx) preferred.