Senior Premium Reconciliation Analyst

JOB SUMMARY:
The Medicare Premium Reconciliation Analyst is responsible for reconciling information from premium reports received from the Centers for Medicare and Medicaid Services (CMS) for AMERIGROUP Medicare members with member information and premium accruals within the FACETS information system. Following identification and analysis of each variance, the Analyst determines the corrective actions to be taken to resolve variances between plan and CMS records. The Analyst researches and resolves fundamental errors and performs quality assurance functions, communicating issues requiring resolution to the Director of Premium Integrity

PRIMARY RESPONSIBILITIES:
The Analyst is responsible for the monthly financial reconciliation of premium for one or more assigned Medicare markets. The Analyst researches, resolves and/or communicates information concerning variances and fundamental errors identified through the reconciliation process. Specific tasks include:

•Reconciles member premiums received to related FACETS accruals for assigned market(s).
•Identifies and analyzes specific variances in data affecting plan payments, including member demographic data, risk adjustments factors, county payment rates and special statuses.
•Analyzes affects of retroactive changes and allocates payment adjustments to appropriate time periods.
•Determines steps to be taken to correct variances, implements corrections as required and/or communicates to appropriate individuals for correction.
•Tracks and verifies application of adjustments through the reconciliation process.
•Serves as liaison between AMERIGROUP and CMS counterpart. Escalates higher-level payment issues to team lead and/or manager as appropriate.
•Communicates appropriate reconciliation adjustments to the Finance Department.
•May interface with IT, Pharmacy and Claims department on issues relating to submission of encounter data.
•Interfaces with health plan staff and SSO management as needed to ensure they are aware of relevant issues or trends.
•Identifies and communicates FACETS systems issues to supervisor.
•Undertakes special reconciliation projects for the department and other duties as assigned
•Creates and distributes monthly reconciliation reports.
•Other Duties as Assigned
REQUIREMENTS
EDUCATION AND EXPERIENCE:
Education
Required: BA/BS required or equivalent experience.

Preferred:
Years and Type of Experience
Required:
•Three years’ prior experience in health care or health insurance, with at least one year in an accounting, financial or information analysis role.
•Experience with management information systems, database, word processing and spreadsheet applications required.
Preferred:
Specific Technical Skills
Required:
Preferred:
Certifications or Licensure
Required:
Preferred:
Other
Required:
•Excellent computer skills and proficiency with MS Excel, Word and Access; knowledge of FACETS system a plus.
•Able to organize and manipulate large amounts of financial and member data.
•Understanding of databases, database field structure, data manipulation and query techniques.
•Detail-oriented with excellent analytical skills, able to identify problems and develop solutions.
•Knowledge of federal regulations and processes relating to Medicare Advantage program payments a plus.
•Good written and verbal communication skills.
•Initiates and maintains productive working relationships with AMERIGROUP associates and customers.
•Able to manage multiple tasks and adapt to changing priorities in a demanding work environment
Preferred:

SCOPE INFORMATION

ItemMeasure
•# Direct Reports
•# Indirect Reports
•Budgetary $ Responsibility
•


PHYSICAL REQUIREMENTS
•Working on PC/CRT for extended periods of time.
•The ability to effectively utilize office telephone equipment.
•Repetitive motions using fingers and forearms.
•Specific vision abilities requiring close vision.

Please apply online at: www.amerigroupcorp.com