Why MediGold?
MediGold 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.
Position Highlights and Benefits:
- 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.
- Relocation assistance (geographic and position restrictions apply).
- Discounted tuition and enrollment opportunities at the Mount Carmel College of Nursing.
- Employee Referral Rewards program.
- Mount Carmel offers DailyPay - if you’re hired as an eligible colleague, you’ll be able to see how much you’ve made every day and transfer your money any time before payday. You deserve to get paid 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 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!
Our Commitment to Diversity and Inclusion
Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is 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, status as a protected veteran, or any other status protected by law.
