Note: The job is a remote job and is open to candidates in USA. Mount Carmel Health System is seeking a Reconciliation Analyst to support its Medicare Managed Care health plan operations. The role manages enrollment, disenrollment, membership data, CMS transactions, billing, premium payments, reporting, and reconciliation processes to ensure regulatory compliance and accurate financial reimbursement.
Responsibilities
- Reviews and processes election forms, including all required data elements, and establishes group and member enrollment records, in accordance with department standards, policies and procedures
- Assures provision of timely and accurate enrollment information (letters, certificates, , Federally required notifications, ID cards, etc.) to members in accordance with Federal requirements and timeframes aligned with department standards, policies and procedures
- Receives and reconciles the CMS transaction reply reports against the membership files of the health plan in accordance with department standards, policies, and procedures to ensure accuracy and meet Federal requirements
- Audits and reconciles membership data between the enrollment system and other systems and corrects any fallout to ensure accurate membership, claims processing and health care management
- Handles sensitive or complex enrollment and disenrollment requests to address customer issues or complaints
Skills
- • Education: Associates degree in business or related field preferred or equivalent experience required
- • Experience: Managed care insurance industry experience required
- Medicare Advantage experience would be helpful along with knowledge of Medicare rules and regulations, specifically around Enrollment and/or sales
Benefits
- Remote opportunity
- Medical, dental, and vision coverage starting on day one
- Retirement savings account with employer match starting on day one
- Generous paid time off programs
- Employee recognition programs
- Tuition/professional development reimbursement starting on day one
- RN to BSN tuition 100% paid at Mount Carmel’s College of Nursing
- Relocation assistance (geographic and position restrictions apply)
- Employee Referral Rewards program
- DailyPay for eligible colleagues, allowing them to see how much they’ve made every day and transfer their money any time before payday
- Opportunity to join Diversity, Equity, and Inclusion Colleague Resource Groups
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