Reconciliation Analyst
Employment Type:
Full timeShift:
Day ShiftDescription:
*REMOTE OPPORTUNITY*This position is temporary/seasonal through April 2027. The schedule is M-F, 8am-4:30pm EST. Medicare Advantage experience would be helpful along with knowledge of Medicare rules and regulations, specifically around Enrollment and/or sales.
Position Purpose:
In accordance with the Mission, Core Values and Vision; the Reconciliation Analyst plans, organizes, conducts and monitors the enrollment and reconciliation process to ensure the accuracy of Medicare Managed Care membership data and enrollment processing, application and reconciliation of all data and payments from the Centers for Medicare and Medicaid Services (CMS) as well as accurate billing and premium payment reconciliation of the plan's membership.
Organizes, conductsand monitorsall transactions to and from CMS, including the special status tracking process, to ensure accuratereporting and payment from CMS for enrollees who fall into a special payment status category. Prepares and summarizes required reporting for enrollment, disenrollment, billingand special status ensuring accuratefinancial reimbursement to the plan.
Responsible for all eligibility and membership functions relating to enrollment, disenrollment, special status, provider attribution, requiredcommunications, billing, premiums, revenueand reconciliation processes for the health plan in accordance withFederal regulatory requirements and (CMS). Responsible for ensuring the eligibility, demographic data, billing, and revenue for membership is accurate. Organizes, conducts, and monitorsthe enrollment and billing processes to ensure accurateand timelytransactions and revenue from CMS and members.
What You Will Do:
Reviews and processes election forms, including all required data elements, and establishesgroup and member enrollment records, in accordance withdepartment standards, policies and procedures.
Assures provision of timelyand accurateenrollment information (letters, certificates, ,Federally requirednotifications, ID cards, etc.) to members in accordance withFederal requirements and timeframesaligned with department standards, policiesand procedures.
Receives and reconciles the CMS transaction replyreports against the membership files of the health plan in accordance withdepartment standards, policies, and procedures to ensure accuracy and meet Federal requirements.
Audits and reconcilesmembership data between the enrollment system and other systems and corrects any fallout to ensure accuratemembership, claims processing and health care management.
Handles sensitive or complex enrollment and disenrollment requests to address customer issues or complaints.
Minimum Qualifications:
Education: Associates degree in businessor related field preferred or equivalent experience required.
Experience: Managed care insurance industry experience required.
Position Highlights and Benefits:
Mount Carmel Health System recognized by Forbes in 2025 as one of America’s Best State Employers.
Competitive compensation and benefits packages including medical, dental, and vision with 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.
Relocationassistance(geographic and position restrictions apply).
Employee Referral Rewards program.
Mount Carmel offers DailyPay- if you’rehired as an eligible colleague, you’llbe able to see how much you’vemade every day and transfer your money any time before payday. You deserve to getpaid every day!
Opportunity to join Diversity, Equity, and Inclusion Colleague Resource Groups.
Ministry/Facility Information:
Mount Carmel, a member of Trinity Health, has been a transforming healing presence in Central Ohio for over 135 years. Mount Carmel serves over 1.3 million patientseach year at our five hospitals, free-standing emergency centers, outpatient facilities, surgery centers, urgent care centers, primary care and specialty care physician offices, community outreach sitesand homes across the region. Mount Carmel College of Nursing offers one of Ohio's largest undergraduate, graduate, and doctor of nursingprograms. If you’reseeking a rewarding career where your purpose, passion, and desire to make a difference come alive, we invite you to consider joining our team. Here, care is provided by all of us For All of You!
Our Commitment
Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.