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Job Summary
This position is responsible for data management, submission and reconciliation of discrepancies as well as analysis and reporting for Medicaid member premium from State Government, which will be used by the Medicare member reconciliation manager as well as within all levels in the organization.
This position is responsible for maintaining the database of all member variable data, creating, submitting compliant reports and reconciling member data from the Medicaid population, CMS reports and submissions to CMS of member related data that affects payment from CMS computes members premium from CMS and creates necessary reports and dashboards.
Imports data from CMS, plan and vendor sources and ensures data quality in reports or files submitted to CMS, including resolution of Medicaid status, late enrollment penalty status, Medicare as secondary payment status, state and county code discrepancies related to Medicaid Government contract procedures, facilitating the coordination and cooperation of internal as well as external stakeholders to resolve discrepancies in matters related to CMS premium reconciliation management and the participation of other operational and financially based reconciliation activities as needed.
JOB REQUIREMENTS:
- Bachelors degree in Accounting, Finance, or related field; 4 years experience in health care, managed care, health insurance or consulting.
- Experience with overall Medicare Advantage payment methodology and CMS Payments, Medicaid, primarily in regard to members demographic status (i.e. Medicaid, State & County Codes), Late Enrollment Penalty, LIS, Medicare as Secondary Payer, among others.
- Experience with SQL, SAS and MS Excel including data import, manipulations and extraction, report development and ad hoc programming. Analytical and verbal and written communication skills.
- Ability to work with stakeholders within enterprise as well as external vendors.
- Time management and multitasking skills and the ability to work with multiple deadlines.
PREFERRED JOB REQUIREMENTS:
- Masters Degree or certification in Accounting, Finance, or related field. Knowledge and experience on Medicaid Member and Enrollment processes.
- Power BI.
- Medicaid.
Please note: This is a hybrid role and will work in the office three days a week.
Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!
HCSC Employment Statement:
We are an Equal Opportunity Employment / Affirmative Action employer dedicated to providing an inclusive workplace where the unique differences of our employees are welcomed, respected, and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.
Base Pay Range
$53,500.00 - $118,100.00
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