Reconciliation Analyst

Employment Type:
Full time Shift:
Day Shift

Description:
*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, conducts and monitors all transactions to and from CMS, including the special status tracking process, to ensure accurate reporting and payment from CMS for enrollees who fall into a special payment status category. Prepares and summarizes required reporting for enrollment, disenrollment, billing and special status ensuring accurate financial reimbursement to the plan.


Responsible for all eligibility and membership functions relating to enrollment, disenrollment, special status, provider attribution, required communications, billing, premiums, revenue and reconciliation processes for the health plan in accordance with Federal regulatory requirements and (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 Will Do:

• 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.

Minimum Qualifications:

• Education: Associates degree in business or 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.

• Relocation assistance (geographic and position restrictions apply).

• 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

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.