Reconciliation Analyst

Healthplan Services Tampa , FL 33602

Posted 4 months ago

The Reconciliation Analyst, Health Insurance Exchanges, will be responsible for working and reconciling the membership data of the health care exchange business carriers that HPS serves. The analyst's main functionality/goal will be to ensure this membership data is correct and accounted for and variances can be identified, root-caused/explained, and ultimately reported and remediated. This would be for daily, monthly, and APTC (Advanced Premium Tax Credit) reconciliation.

Job Functions:

  • Analyze daily summary reporting of processed enrollment transactions received from the Exchanges to identify discrepancies

  • Analyze daily summary reporting of received enrollment transactions to ensure receipt of all transactions

  • Identify/analyze/root cause discrepancies between enrollment/eligibility files (834 transactions) and payment files (820 transactions)

  • Daily working of membership data discrepancies between the Health Care Exchanges and HPS; Between HPS and the Carriers

  • Collect data from all resources and cross functional departments where applicable to resolve discrepancies

  • Understand Federal and State regulations to ensure accurate interpretation and processing of data

  • Ensure compliance is met with federal and state regulations. Ensure company guidelines, policies, and procedures are adhered to

  • Apply appropriate disposition and/or action to resolve discrepancies

  • Work daily exceptions and failed transactions and communicate to internal departments, federal, and state exchanges as needed

  • Ability to communicate effectively and efficiently of tracked high risk discrepancies to management (i.e. early detection, trend identification)

  • Communicate clearly with Carrier partners any discrepancy concerns and provide resolution in a timely and equitable manner within the guidelines of company policies and procedures, as well as Federal and State Regulations

  • Perform daily and monthly QA Analysis on completed discrepancies for accuracy

  • Present monthly QA reporting on error rate which will outline gaps in process

  • Train and mentor new associates on Reconciliation process through approved and documented Step Actions

  • Perform UAT (User Acceptance) testing where applicable (i.e. on new processes, system changes/modifications, user interfaces of operating systems)

  • Create and update Step Action Procedures as needed for business processes

  • Complete discrepancy resolution within outlined SLA time frames as well as within quality parameters

  • Utilization and understanding of multiple tools and systems to be able to root cause and resolve discrepancies

  • Interface with Federal and state-based systems and employees to resolve issues in a timely manner

  • Work cross-functionally with other internal departments where applicable to resolve items

  • Understand complex EDI (Electronic Data Interface) transactions to be able to ascertain where potential problems lie

  • Be able to read and interpret Business Rules for automated processing of transactions to understand if processing logic is being applied

  • Strong interpersonal and relation skills

  • Critical thinking and analytical problem solving

  • Presentation Skills

  • Ability to maintain confidentiality in all aspects of the job

  • Ability to manage multiple task with minimum direction

  • Ability to manage priorities and complete task in a timely manner within outline time frame

  • Ability to communicate, interact and work effectively and cooperatively with all external and internal customers

  • Ability to recognize the importance of HIPAA Regulations and importance of confidentiality

  • Experience with 834/820 enrollment and financial data

  • Preferred background in government sponsored programs (Medicare, Medicaid)

  • H.S. Diploma or higher

Communication: Ability to effectively communicate to Supervisor/Manager as well as team members/peers. Able to communicate issues, results, needs, concerns to Leadership. Effectively communicate with other departments and work cross-functionally. Capable of communicating critical and analytical thinking to ensure maximum understanding and output is reached. Assist in meetings and potential testing where applicable.


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Reconciliation Analyst

Healthplan Services