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 Enrollment Reconciliation Auditor

Country: USA
Location: Phoenix AZ
Total applied: 40

Base Pay:N/A
Employee Type:Full-Time Employee

Industry:Healthcare - Health Services

Manages Others:no
Enrollment Reconciliation Auditor

Summary/Position Objectives:
Under the general supervision of the Member Services Manager, this position is primarily responsible for the reconciliation of Maryland Physicians Care (MPC) Medicaid members. Reviews and analyzes eligibility data for discrepancies that may affect the maximization of benefits to MPC/SAMD and its business partners. Identify and profile variations in State Capitation relative to enrollment and claims payments. Works with IT and the Finance department in the development of audit and reporting requirements to minimize exposure and identify recovery opportunities. Ascertains areas of improvement and resolution, allowing for better service to the MPC member.

Essential Functions:
Supervises the eligibility load into the database and data viewer by monitoring production schedules, confirming pre/post processing of files.
Facilitates the development of enrollment load error and edit procedures & reports to ensure adequate reconciliation of data.
Reviews and validates eligibility data to ensure accuracy of the information transmitted and loaded into the database.
Reconciles enrollment, identifies discrepancies and determines the most effective method to resolve the issue.
Reports discrepancies and resolution recommendations to management.
Confirms updates to enrollment and/or eligibility are appropriately processed in the databases.
Researches and resolves complex enrollment issues.
Identifies areas of improvement and assists with the development of audit reports.
Analyzes and profiles variations in capitation payment and enrollment ensuring timely and appropriate adjustments to eligibility.
Performs enrollment, capitation and claims paid comparisons, to identify disparities in allocation and payments received and notify management of recovery opportunities.
Develops and maintains tracking processes to record and monitor missing capitation payments.
Works with management to implement system changes to enhance automated processes through various systems software designs.
Maintains above average knowledge base of MPC and Medicaid policies and procedures and desktop procedures adhering to guidelines consistently.
Communicates effectively with management and follows appropriate chain of command with regard to departmental issues, and member enrollment and eligibility issues.
Maintains confidentiality of member enrollment information.


Schaller Anderson administers Medicaid and employer self-funded health plans, and manages behavioral health plans. The companyís suite of services includes member services; provider services; claims processing; information services; financial reporting and analysis; medical management; and grievances and appeals services. Schaller Anderson has also been engaged in several consulting projects for states, health plans and providers. Schaller Anderson and its affiliates have 1,400+ employees nationwide and administer health plans with over 1.6 million members. Recently, the Initiative for a Competitive Inner City and Inc. magazine named Schaller Anderson to the Inner City 100, a list that recognizes the fastest-growing companies in Americaís core urban areas. Schaller Anderson placed eighth among 5,000 entries in the Inner City 100 competition and was the only health care management company in the top 10.

The VISION of Schaller Anderson, Inc. is to be recognized as the nationís foremost managed care resource by providing the highest value management and consulting services throughout the health care continuum.


Schaller Anderson team members are provided with countless opportunities to make a real difference and the following compensation/benefits:

* Competitive compensation DOE
* Medical, Dental and Vision insurance
* Employee Assistance Program
* Flexible spending accounts
* On-site fitness center (Phoenix headquarters only)
* Life insurance and accidental death and dismemberment insurance
* Short-term and long-term disability
* Paid holidays, paid time off/paid time off reserve
* 401(k) and profit sharing
* Tuition reimbursement
Knowledge and Skills:
Effective oral and written communication skills; detailed documentation skills required.
Effective analytical, organizational and problem-solving skills.
Ability to take complex problems and communicate clear, concise and professional customer responses.
Ability to perform statistical functions and maintains accurate enrollment records.
Ability to multi-task in a fast-paced work environment.
Proficiency in Microsoft Office software applications and common computer and office hardware.
Ability to be tactful and to be a team player.

Educations and Experience:
Bachelor degree in closely related field is preferred, although an equivalent combination of formal education and experience within a managed health care or government health care (Medicaid) work environment may substitute for a degree. Enrollment membership experience is also preferred.

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