Reconciliation Analyst

Position Summary

The Reconciliation Analyst is responsible for the timely and accurate resolution of discrepancies identified during the reconciliation of the information in the client's platform against data maintained within the CMS, SSA or client identified systems as well as for the accurate processing of CMS transactions that are not automatically processed by the applicable systems.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Review identified discrepancies between the information within the Medicare Services Platform and the monthly files from government agencies and client systems including but not limited to the CMS Full File, the Payments Withholding Report and the Claim Processor Reconciliation Files.

Take appropriate action, based on the discrepancy, to correct the information in the system identified as being incorrect and trigger any communication necessary based on the resolution.

Take all steps required by departmental policies to process CMS transactions that do not automatically process including, but not limited to, updating customer accounts, updating client systems and triggering customer communication

Draft and submit audit response packages in support of the monthly Enrollment Data Validation in accordance with CMS and Reed & Associates processes

Draft and submit retroactive transaction requests to the Retroactive Processing Contractor in accordance with departmental policies and CMS/Reed & Associates processes

Review and correct or escalate for correction errors in fulfillment that prevent customer communication from being sent to customers

Prepare reports as requested by management.

Display positive demeanor, technical accuracy, and conformity to company policies.

Understand CMS Guidance and ensure that communication is in accordance with CMS Guidance.

Ensure HIPAA regulations are maintained within the immediate environment.

Documentation is detailed and concise as it pertains to member records.

Identifies need for outbound calls for purposes of validating information and addresses and conducts member outreach.

Communicate with coworkers, management, staff, customers, and others in a courteous and professional manner.

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

Respond promptly when replying to correspondence and faxes.

Act, dress, and behave in a professional manner to reflect a positive image of the company.