Membership Reconciliation Analyst

2322

Remote?: 1

Highlights (Bonus, shift, relocation, info for job):

Job Summary 

 

As the Membership Reconciliation Analyst (MRA), you will play a vital role, focused on reconciling our membership against our Payer partner records, ensuring accuracy. This position supports our Member Operations and Eligibility Specialist Teams, playing a key part in ensuring accurate panel tracking and reporting. This role will be responsible for conducting timely reporting and analysis and offering improvement recommendations to enhance the panel management processes.  

 

The MRA role will also be responsible for tracking reconciliation results and reporting to leadership monthly.   Engaging in membership eligibility research will require critical thinking skills and the ability to analyze data from various sources to do a root cause analysis and solve complex data reconciliation challenges.  

 

The MRA promotes the mission, vision, and values of AbsoluteCare and extends 5-star customer service in all interactions. This is a remote position. 

 

Duties and Responsibilities 

• Read, interpret, and understand payer contract terms, and maintain a knowledge and expertise of eligibility requirements for each assigned payer contract. 

• Collecting and analyzing membership data from health plan partners 

• Identifying discrepancies between health plan partner data and AbsoluteCare data and conducting root cause analysis to identify the approach and ownership to resolution. 

• Understand and use various state and payer portals comparative to payer attribution files and categorize differences across our data 

• Document membership implications of panel discrepancies and contribute to reconciliation workflows. 

• Coordinating with Member Operations and Eligibility Specialist for resolution of discrepancies, ensuring they are resolved timely, and auditing resolution in member panel accuracy. 

• Understand AbsoluteCare enrollment processes to support discrepancy resolution 

• Conduct timely reporting and offer process improvement recommendations based on data analysis. 

• Download reconciliation results into reporting tools and track status of discrepancies  

• Complete other duties as assigned including special assignments and projects instrumental to the department's function. 

 

Minimum Qualifications 

 

• A Bachelor's degree in related field i.e. Reconciliation, business informatics, Auditing, Accounting, or Analytics. 

• 2+ years of experience in Reconciliation, Auditing, Accounting, or Analytics. 

• Health insurance and government programs experience required, specifically with Medicaid Managed Care and Medicare Advantage programs, eligibility, and enrollment 

• Requires excellent critical thinking, root cause analysis, and problem-solving skills  

• Requires independent working and problem solving 

• Requires excellent written and verbal communication skills with the ability to communicate and present effectively in large forums to discuss complex information 

• Requires extensive experience with excel and SQL 

• Good computer skills including Microsoft Office Suite (Outlook, Excel, PowerPoint, Word) and electronic medical record documentation required.   

• Requires good written and oral communication skills and the ability to work closely with co-workers, patients, family members, and State agencies. 

 

Working conditions 

 

This job operates in a remote location from your home location.  This role requires a dedicated, quiet workspace with the ability to adhere to HIPPA and other privacy policies.  A reliable and high-speed Wi-Fi connection or home internet is required to perform the essential functions of this role. 

 

Physical requirements 

 

• Ability to remain stationary for extended periods while working at a desk or workstation. 

• The role requires frequent use of a computer, including typing on a keyboard and using a mouse. Manual dexterity and hand-eye coordination are essential for efficiently completing tasks and navigating various software systems. 

 

Direct reports 

 

None

Why Work at AbsoluteCare?

At AbsoluteCare, we serve the most vulnerable individuals in America. These are our neighbors, people who are at higher risk for disease or who have multiple, complex, chronic illnesses. Often, they deal with an unequal healthcare system and wind up seeking basic care from emergency rooms. We take these patients out of those spaces and turn them into members: people who are entitled to some of the best, most focused care this country has to offer. 

We call this “care beyond medicine.” We have turned the doctor’s office into a comprehensive care center. Here, we surround our members with a core care team of doctors, nurses, social workers, and medical assistants who have the time and skills to get to know our members’ needs. We make the most important services available to our members under one roof. This includes a pharmacy, X-rays, a blood lab, nutrition services, urgent care, and much more.

We don’t stop at our four walls. We engage members in the communities where we all live to find the people who need us most. Through these community care teams, we remove the barriers to healthcare that so many people face daily. And it works. 

Our unique care is guided by our core values of accountability, caring, trust, and teamwork. We call it ACT².

AbsoluteCare, Inc. provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, age, disability, genetics, protected Veteran status, or any other characteristic protected by law or policy.

EEO Employer Verbiage: AbsoluteCare, Inc. provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, age, disability, genetics, protected Veteran status, or any other characteristic protected by law or policy.