Medicare Enrollment Reconciliation Analyst

Description 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 very closely with AVP of Member Experience and reports directly to Enrollment Manager. 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. Assist 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 Benefits: 401(k) Dental Insurance Health insurance Life insurance Paid time off. Vision insurance Schedule: 8-hour shiftMonday to Friday/Weekends as needed 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. #J-18808-Ljbffr

Created: 2025-03-01