Medicare Enrollment Reconciliation Pro

AlohaCare; Honolulu (HI); On-site; USD 23,000 - 30,000; Full time

Job summary

AlohaCare is seeking an Enrollment Reconciliation Specialist to oversee Medicare D-SNP enrollment reconciliation and CMS/MARx transactions. This role identifies and resolves complex enrollment discrepancies affecting member eligibility, claims, and benefits.

The position collaborates with Enrollment and Plan Operations, CMS, and other stakeholders to ensure accurate data and timely reconciliation across systems, plus leadership reporting on status and risk.

Qualifications

• High school diploma or equivalent.
• 3+ years in healthcare enrollment, Medicare Advantage, D-SNP, membership or health plan operations.
• Strong knowledge of CMS/MARx enrollment processes.
• Experience with Medicare Advantage and D-SNP/Medicaid populations preferred.
• Advanced Excel and data-reconciliation skills.
• Ability to research complex enrollment issues and determine resolutions.

Responsibilities

• Identify and investigate discrepancies between CMS/MARx and downstream systems.
• Research root causes and develop corrective actions.
• Manage reinstatements, retroactive enrollment changes, and CMS corrections.
• Reconcile Medicare D-SNP enrollment with Medicaid/QUEST eligibility.
• Validate enrollment changes and downstream impact on claims and benefits.
• Maintain reconciliation trackers, logs, and management reporting.
• Provide guidance to enrollment staff on reconciliation issues and CMS transactions.
• Develop reporting to show leadership enrollment status, discrepancies, activity and risk.

Skills

Advanced Excel

Data reconciliation

CMS/MARx knowledge

Communication skills

Customer service

Problem solving

Education

High school diploma or equivalent

Tools

MS Word

MS PowerPoint

Job description

AlohaCare is seeking an Enrollment Reconciliation Specialist to oversee Medicare D-SNP enrollment reconciliation and CMS/MARx transactions. This role identifies and resolves complex enrollment discrepancies affecting member eligibility, claims, and benefits.

The position collaborates with Enrollment and Plan Operations, CMS, and other stakeholders to ensure accurate data and timely reconciliation across systems, plus leadership reporting on status and risk.