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Reconciliation Analyst (Seasonal) MediGold

Trinity Health • Columbus, OH • 15h ago

Employment Type:

Full time

Shift:

Description:

Why MediGold?

MediGold (https://medigold.com/) is a not-for-profit Medicare Advantage insurance plan serving seniors and other Medicare beneficiaries across the United States. We're dedicated to providing excellent customer service, cost-effective care, and exceptional healthcare coverage. We rely on talented colleagues in a wide variety of professional roles including information technology, financial analysis, audit, provider relations and more.

About the job:

Reconciliation Analyst plans, organizes, conducts and monitors the enrollment and reconciliation process to ensure accurate membership processing, application and reconciliation of all data and payments from CMS as well as accurate billing and premium payment reconciliation of the plan's membership

Organizes, conducts and monitors the special status tracking process to ensure accurate reporting and payment from CMS for enrollees who fall into a special payment status category.

Responsible for all eligibility and membership functions relating to enrollment, disenrollment, special status, billing, premiums, revenue and reconciliation processes for the health plan in accordance with Federal regulatory requirements and the Centers for Medicare and Medicaid Services (CMS). Responsible for ensuring the eligibility, demographic data, billing and revenue for

membership is accurate. Organizes, conducts, and monitors the enrollment and billing processes to ensure accurate and timely transactions and revenue from CMS and members

What you'll do:

Assures provision of timely and accurate enrollment information (letters, certificates, Member Agreement, handbooks, ID cards, etc.) to members, in accordance with department standards, policies and procedures.

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.

Maintains current knowledge of CMS regulations related to enrollment, disenrollment, billing, and special statuses.

Compile information and documentation to support special status payment requests to governmental agencies.

Respond to written and verbal requests for information from federal and local Government agencies such as CMS, or state department of insurance.

Monitors and effectuates membership and financial transactions including payment posting, reconciliation, electronic funds transfer posting and maintenance, late letter process, processing of returned payments, billing statements, evaluation and completion of required reporting.

Willingness to learn and comprehend various aspects of Plan and identify engagement opportunities and integration points.

What we're looking for:

Education: Associates degree in business or related field preferred or equivalent experience required.

Experience: Managed care insurance industry experience required.

Able to apply regulations to work processes.

Proven ability to successfully work with internal and external groups to accomplish reconciliation of payment reports and activities.

Proven skill and ability to track and report financial and statistical data.

Knowledge of computer systems including Microsoft Office.

Service-oriented individual with an ability to effectively resolve customer issues.

Analytical and problem solving skills.

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 patients each 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 sites and homes across the region. Mount Carmel College of Nursing offers one of Ohio's largest undergraduate, graduate, and doctor of nursing programs. If you're seeking 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!

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.

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.

Our Commitment to Diversity and Inclusion

Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.

EOE including disability/veteran

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