Medicare Enrollment Reconciliation Specialist

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

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