Job Description
Job Title: Membership Accounting Analyst
The Membership Accounting Analyst is responsible for the timely and accurate resolution of discrepancies identified in the Enrollment, Billing and/or Reconciliation processes. The analyst will review documentation, work items in queues and correct errors, identify trends and document resolutions.
Essential duties and Responsibilities:
Enrollment Processing
- Process queue items, inter-departmental and customer requests timely and accurately
- Review incomplete and pending enrollment applications and disenrollment forms for correction and submission to Centers for Medicare & Medicaid Services (CMS)
- Review and complete Late Enrollment Penalty (LEP) Attestations
- Review and complete Other Health Insurance (OHI) verification and error correction
- Review and create retro processing packets to be submitted to the CMS Retro Processing Contractor (RPC)
Billing Processing
- Identify and post customer payments not automatically applied by the appropriate system
- Respond to billing-related correspondence
- Review and investigate returned checks, rejected ACH and credit card transactions
- Process requests for automated premium payment via credit card or ACH withdrawal
- Review and approve/deny customer requests for premium refunds in accordance with established policies
- Monthly State Pharmaceutical Assistance Programs reconciliation
Reconciliation Processing
- Researching and correcting errors, discrepancies, and rejected transactions received from:
- CMS on the Daily Transaction Reply Report (DTRR)
- CMS Daily and Monthly Reconciliation queues
- Daily and Monthly Pharmacy Benefit Manager (PBM)
- Monthly MMR, PWR, LIS History and LEP Reconciliation
- Daily OHI/COB Rejections
- Monthly review and preparation of the CMS Enrollment Data Validation file and submissions
All Functions
- Working understanding of Centers for Medicare & Medicaid Services (CMS) guidance
- Conform with and abide by all regulations, policies, work procedures and instructions
- Meet CMS guidelines and client Service Level Agreement (SLA) requirements through the proper handling of transactions
- Perform outbound calls to customers or other entities as permitted to complete processing of enrollment, disenrollment, billing and or reconciliation transactions
- Make appropriate system corrections and escalate transactions that are unable to be corrected
- Prepare reports as requested by management
- Perform other duties and responsibilities as required
Education and Experience:
- High school diploma required; Associates Degree or higher preferred
- Minimum 2 years Health Plan Operations experience including; Enrollment (preferred), Claims processing or Customer Service.
- Working knowledge of MSOffice (Word, Excel, Outlook)
Qualifications
About Us
Convey Health Solutions, together with Pareto Intelligence™, delivers a powerful combination of purpose-built technology, advanced analytics, and expert services to help health plans thrive in a complex, post--Affordable Care Act environment.
As a trusted partner to Medicare and commercial payers, we provide scalable, compliant solutions that span the entire member lifecycle--from enrollment and billing to risk adjustment, Stars performance, and member engagement. Pareto's deep analytics and financial intelligence complement Convey's operational expertise, enabling our clients to improve performance, reduce costs, and create better healthcare experiences for millions of Americans--especially seniors and vulnerable populations.
Together, we help health plans scale smarter, grow stronger, and make healthcare work better for the people who need it most. Learn more at http://www.ConveyHealthSolutions.com
