Sr. Reconciliation Coordinator-Medicare

SCOPE OF POSITION:
Responsible for coordinating activities involving the reconciliation of Medicare Premium, but not limited to the following: the timely identification and resolution of demographic and risk discrepancies, the review of expected revenues and their correlation with actual payment from CMS. This position also works on special projects as assigned by management.ESSENTIAL JOB FUNCTIONS:
·Keep Abreast of regulatory changes/developments affecting the enrollment and reconciliation of Medicare members, and procedural changes necessary to comply with these requirements.·Act as a primary liaison between Medicare Member Processing, Claims Data Management, and Plan Data Management and IS to resolve Medicare premium reconciling issues and problems.
·Prioritize and monitor the review of financial and non-financial Medicare premium discrepancies
·Ensure that corrections and related notes are input in E*Log
·Coordinate the submission of retro-request to CMS.
·Coordinate and ensure timely follow-up on change requests pending with to CMS.
·Work closely with Claims Data Management to proactively identify risk factor related adjustments.
·Develop trending reports to help forecast potential recoveries/reimbursements.·Provide weekly status reports to AR/MPD management·Develop monthly summary to update Finance.
·Maintain adequate security over member records and other confidential data as prescribed by company policies and required by State and Federal law, including HIPAA privacy and security provisions.
REQUIREMENTS
QUALIFICATIONS:
·Bachelor degree, preferably in a business related discipline.
·Knowledge of Medicare enrollment process and payment methodology preferred.CRITICAL SKILLS/EXPERTISE:
·Strong verbal and written communication skills.·Strong analytical and interpretative skills
·Good organizational skills
·Proficient knowledge of PC and applications programs, particularly Windows word-processing and spreadsheet programs, desirable.
·Knowledge of Amisys, preferred.