Job Description

Job Title: Membership Accounting Analyst

Position Summary:

The Membership Accounting Analyst is responsible for the timely and accurate resolution of discrepancies identified in the Enrollment, Billing and/or Reconciliation processes. The analyst will review documentation, work items in queues and correct errors, identify trends and document resolutions.

Essential duties and Responsibilities:

Enrollment Processing

Process queue items, inter-departmental and customer requests timely and accurately

Review incomplete and pending enrollment applications and disenrollment forms for correction and submission to Centers for Medicare & Medicaid Services (CMS)

Review and complete Late Enrollment Penalty (LEP) Attestations

Review and complete Other Health Insurance (OHI) verification and error correction

Review and create retro processing packets to be submitted to the CMS Retro Processing Contractor (RPC)

Billing Processing

Identify and post customer payments not automatically applied by the appropriate system

Respond to billing-related correspondence

Review and investigate returned checks, rejected ACH and credit card transactions

Process requests for automated premium payment via credit card or ACH withdrawal

Review and approve/deny customer requests for premium refunds in accordance with established policies

Monthly State Pharmaceutical Assistance Programs reconciliation

Reconciliation Processing

Researching and correcting errors, discrepancies, and rejected transactions received from:

CMS on the Daily Transaction Reply Report (DTRR)

CMS Daily and Monthly Reconciliation queues

Daily and Monthly Pharmacy Benefit Manager (PBM)

Monthly MMR, PWR, LIS History and LEP Reconciliation

Daily OHI/COB Rejections

Monthly review and preparation of the CMS Enrollment Data Validation file and submissions

All Functions

Working understanding of Centers for Medicare & Medicaid Services (CMS) guidance

Conform with and abide by all regulations, policies, work procedures and instructions

Meet CMS guidelines and client Service Level Agreement (SLA) requirements through the proper handling of transactions

Perform outbound calls to customers or other entities as permitted to complete processing of enrollment, disenrollment, billing and or reconciliation transactions

Make appropriate system corrections and escalate transactions that are unable to be corrected

Prepare reports as requested by management

Perform other duties and responsibilities as required

Education and Experience:

High school diploma required; Associates Degree or higher preferred

Minimum 2 years Health Plan Operations experience including; Enrollment (preferred), Claims processing or Customer Service.

Working knowledge of MSOffice (Word, Excel, Outlook)

About Us

About UsConvey Health Solutions, together with Pareto Intelligence, delivers a powerful combination of purpose-built technology, advanced analytics, and expert services to help health plans thrive in a complex, post--Affordable Care Act environment.As a trusted partner to Medicare and commercial payers, we provide scalable, compliant solutions that span the entire member lifecycle--from enrollment and billing to risk adjustment, Stars performance, and member engagement. Pareto's deep analytics and financial intelligence complement Convey's operational expertise, enabling our clients to improve performance, reduce costs, and create better healthcare experiences for millions of Americans--especially seniors and vulnerable populations.Together, we help health plans scale smarter, grow stronger, and make healthcare work better for the people who need it most. Learn more at http://www.ConveyHealthSolutions.com

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