Medicare Enrollment Reconciliation Expert

Alohacare; Honolulu, Northern (HI, KY); Hybrid; USD 23,000 - 30,000; Full time

Benefits offered by this job

Low-cost medical insurance

Dental and vision insurance

401k employer contribution

Paid time-off

Referral bonus

Job summary

AlohaCare in Hawaii is seeking an Enrollment Reconciliation Specialist to provide advanced operational oversight of Medicare D-SNP enrollment reconciliation and CMS/MARx transactions. You will investigate enrollment discrepancies, coordinate with CMS and internal teams, maintain detailed logs and reporting, and drive process improvements while ensuring compliance with regulations.

The role requires strong Excel and data-reconciliation skills, experience with CMS processes, and the ability to

Qualifications

• Advanced Excel and data-reconciliation skills.
• Experience with Medicare Advantage and preferably D-SNP/Medicaid populations.
• Strong knowledge of CMS/MARx enrollment processes.
• Ability to independently research complex enrollment issues and determine resolution.

Responsibilities

• Research root causes of enrollment discrepancies and develop corrective actions.
• Manage reinstatements, retroactive enrollment changes, and CMS transaction corrections.
• Reconcile Medicare D-SNP enrollment with Medicaid/QUEST eligibility and identify issues.
• Validate enrollment changes and downstream impact on claims, pharmacy, and benefits.
• Maintain reconciliation tracker, issue logs, audit documentation, and management reporting.
• Escalate significant enrollment issues to leadership and ensure compliance with policies.

Skills

Excel

Data reconciliation

CMS/MARx processes

Research complex enrollment issues

Independent working

Tools

Word

Excel

Outlook

PowerPoint

Access databases

Job description

AlohaCare in Hawaii is seeking an Enrollment Reconciliation Specialist to provide advanced operational oversight of Medicare D-SNP enrollment reconciliation and CMS/MARx transactions. You will investigate enrollment discrepancies, coordinate with CMS and internal teams, maintain detailed logs and reporting, and drive process improvements while ensuring compliance with regulations.

The role requires strong Excel and data-reconciliation skills, experience with CMS processes, and the ability to