Reconciliation Analyst
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 preferredRecommended Jobs
Recreation Coordinator/Specialist
Job Description Job Description Job title: Recreational Specialist Reports to: Program Director FLSA Status: Non-Exempt (Hourly) / Full Time Date Issued: March 2021 POSITION SUMM…
Senior Counselor Staff application
Job Description Job Description Description: POSITION SUMMARY: The Senior Counselor is responsible for supervising and managing the daily activities and interactions of a cabin of campers. …
Senior Data Analyst
Job Description THE SELECTED CANDIDATE WILL BE OFFERED A SALARY OF $106,602. THIS POSITION IS ONLY OPEN TO CANDIDATES WHO ARE PERMANENT (NOT PROVISIONAL) IN THE CIVIL SERVICE TITLE OF ADMINIS…
Baker Crumbl Cookies
Job Description Job Description Baker Are you self motivated and looking for more than just a paycheck? If thats you keep reading. Its more than a bakery. It's more than retail. At Crumbl Coo…
Senior Software Engineer, AI Model serving
PLEASE APPLY THROUGH THIS LINK: DO NOT APPLY BELOW Mission The mission of Speechify is to make sure that reading is never a barrier to learning. Over 50 million people use Speechify's …
Catering Services Manager Sr
Job Description The Catering Director is a key leadership role that is responsible for leading the catering operations at a large account or coordinating multiple catering outlets at a single acco…
Family Medicine Physician
We are seeking a Board-Certified (or Board-Eligible) Family Medicine Physician to join our established, physician-led outpatient practice in Saratoga, NY. This is an excellent opportunity to deliver c…
Breakfast Food Runner
Chef Andrew Carmellini is seeking Breakfast Food Runners for his signature restaurant, Café Carmellini at The Fifth Avenue Hotel. Café Carmellini is the signature restaurant from James Bea…
Global Merchandising Associate
Coach is seeking a Global Merchandising Associate for Men's Retail Bags in New York. This role involves supporting the development and execution of merchandising strategies, analyzing market trends, a…
Booker, Mornings with Maria
OVERVIEW OF THE COMPANY Fox Business Network FOX Business Network (FBN) is a financial news channel delivering real-time information across all platforms that impact both Main Street and Wall S…