Department:OH1CH_70512_000 Enrollment & Premium Billing
Expected Weekly Hours:40
Position Purpose:At Mount Carmel, we’re committed to making a meaningful difference in the lives of our patients and communities. Our colleagues – people like you – share our passion for always going above and beyond to provide the highest standards of care.
Job Description Details:
MediGold is a not-for-profit Medical Advantage insurance plan serving seniors and other Medicare beneficiaries in Ohio. We’re dedicated to providing excellent customer service, cost-effective care, and exceptional healthcare coverage. We rely on talented colleagues in a wide variety of professional roles including information technology, financial analysis, audit, provider relations and more.
Our Reconciliation Analyst plans, organizes, conducts and monitors the enrollment and reconciliation process to ensure accurate membership processing, application and reconciliation of all data and payments from CMS. Organizes, conducts and monitors the special status tracking process to ensure accurate reporting and payment from CMS for enrollees who fall into a special payment status category. Organizes, conducts and reconciles the risk score assignment of enrolled beneficiaries to ensure accurate payment and reporting.
- Reviews and processes election forms, including all required data elements, and establishes group and member enrollment records, in accordance with department standards, policies and procedures.
- Reconciles the CMS transaction reply reports against the membership files of the health plan in accordance with department standards, policies and procedures. Contacts applicants to obtain missing or clarifying information related to enrollment and eligibility. Provides customer service for member-specific issues.
- Maintains current knowledge of CMS regulations related to enrollment, disenrollment and special statuses.
- Education: Associates degree in business or related field, or equivalent experience
- Experience: Managed care insurance industry experience required
- Effective Communication Skills. Ability to effectively conduct and monitor multiple procedures simultaneously. Ability to work in multiple computer programs simultaneously. Detail oriented with demonstrated ability to enter data accurately.
- Proven ability to successfully work with internal and external groups to accomplish reconciliation of payment reports and activities.
Discovering opportunities, support and excellence – all while making a real difference in patients’ lives – begins at Mount Carmel. Find a new beginning and advance your career with us.
Mount Carmel and all its affiliates are proud to be equal opportunity employers. We do not discriminate on the basis of race, gender, religion, or physical ability.
Trinity Health's Commitment to Diversity and Inclusion
Trinity Health employs more than 120,000 colleagues at dozens of hospitals and hundreds of health centers in 21 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.
Trinity Health's dedication to diversity includes a unified workforce (through training and education, recruitment, retention and development), commitment and accountability, communication, community partnerships, and supplier diversity.