Reconciliation Analyst

: Overview

Manages and reconciles the administrative functions for enrollment and disenrollment activities; maintains membership status in membership systems and financial data for all special enrollments for all VNS Health product lines. Promotes program growth by solving administrative issues and problems that inhibit VNS Health enrollment and membership retention. Works under general supervision.

Responsibilities • Confirms that final determinations are received for all enrollment applications submitted for VNS Health products. Updates appropriate staff with enrollment activity information. Ensures timeliness of application processing and adherence to policies and procedures. Informs staff of any procedural changes with enrollment. • Coordinates resolutions for problematic pre-enrollment cases. • Reviews disenrollment submissions for VNS Health Plans products. Acts as support and provides guidance to regional/departmental staff regarding appropriate disenrollment processes. • Monitors and reconciles disenrollments from VNS Health Plans products and assists in resolving disenrollment discrepancies. • Reviews Part D reports (e.g. Prescription Drug Event, Plan to Plan Reconciliation) and facilitates plan to plan activities which include PDE error resolution, processing timely payments for Plan to Plan payables, collection of Plan to Plan receivables and incoming/outgoing TROOP transfers. • Assists with monthly analyses of VNS Health Plans enrollment and disenrollment outcomes and prepares various census and membership reports. Maintains census numbers on an ongoing basis. • Reviews internal system reports (e.g. Membership Full File) and various government agency reports (e.g. CMS-TRR, MMR, PDE; DOH Rosters, etc.) and updates membership systems (e.g. Pre-enrollment browser, Mainframe, Salesforce, Facets) to reflect appropriate membership status. • Analyzes membership exception reports, makes decisions regarding the appropriate correction procedure and updates membership systems accordingly. • Acts as first line staff in identifying deficiencies in membership systems and databases, does analysis and makes suggestions for improvement. • Identifies Medicaid eligibility issues and works closely with appropriate departmental staff, Local Department of Social Services (LDSS)/Human Resources Administration (HRA) and Third Party Administrator (TPA) in resolutions. • Facilitates NAMI (Net Available Monthly Income) process for special circumstance enrollees. Maintains necessary financial information and updates appropriate program and contracted NH staff through reports, letters and Facets data entries. • Participates in ongoing meetings with regional/departmental staff, LDSS/HRA, Maximus and TPA to discuss various membership topics. • Assists in maintaining close working relationships with LDSS/HRA, TPA and contracted NH Patient Account departments. Participates in meetings as necessary in order to resolve issues and to develop more effective and efficient workflows. • Assists with the development and production of membership communications/materials, primarily by proof-reading documents. • Provides administrative support to Reconciliation Specialists and MEU Leadership staff. • Prepares and analyzes statistical reports regarding referral, enrollment, disenrollment and membership activities on a scheduled basis (monthly/weekly/daily) for use by VNS Health Plans Leadership staff in order to monitor/project plan growth, membership, trends that impact financial, operational and programmatic areas. • Participates in special projects and performs other duties as assigned. Qualifications Education: Bachelor's Degree in Finance, Business Administration, Health Administration or related field required Work Experience: Minimum three years experience working in a Health Care environment in the areas of finance and/or enrollment. Knowledge of Medicare and Medicaid eligibility requirements. Has a keen attention for detail and a very good understanding of an effective and efficient reconciliation system. Has the ability to work independently and is self motivated. Advanced proficiency with Excel and Word software applications required Effective oral, written and interpersonal communication skills required Managed care experience preferred