Job Description
MMM of Florida, a proud member of the InnovaCare Health family of companies, a powerful combination and the foundation upon which we're expanding. InnovaCare Health is the 9th largest Medicare Advantage provider in the U.S. MMM of Florida is a licensed HMO, NCQA accredited, that serves individuals enrolled in MedicareAdvantage plans. Join us, this is an exceptional opportunity to do innovative work for the benefit of those we serve.
We currently have an opening for a Reconciliation Analyst. This position will be responsible for monthly, weekly and daily reconciliation of CMS memberships and resulting payments, in a manner consistent with regulatory requirements.
ESSENTIAL DUTIES AND RESPONSIBILITIES
- Reconcile monthly, weekly and daily variances within membership database upon CMS monthly, weekly and daily reply listing using the Market Prominence System.
- On a monthly, weekly and daily basis the Reconciliation Analyst will conduct an analysis on the monthly, weekly and daily files received by CMS.
- Determine member’s eligibility according to CMS guidelines and beneficiary trends within the Reply receives in the monthly, weekly and daily files.
- Prepare reconciling reports on a member-level for financial purpose that will impact the financial revenue of the company.
- Develop procedures on handling each type of discrepancies within Government data and Plan Data.
- Reconcile, through appropriate research, past variances in the membership database in accordance with CMS rules and regulations.
- Responsible on updating and compiling any require member information on the OnBase systems.
- Analyze Market Prominence System and QNXT System reports dealing with compliance activities and decision making approaching a resolution for discrepancies identified.
- Maintain a working knowledge of CMS regulatory requirements (and updates) for
- M+C Organizations, especially in the areas of enrollment, disenrollment, Late Enrollment Penalty, Coordination of Benefits, Medicaid, and Membership accounting reconciliation.
- Reconcile COB through appropriate research, requested by members using the Customer Service Application or received by CMS.
- Analyze and resolve Encounters, RAPS & PDE Eligibility transactions errors and take appropriate reconciling actions.
- Monitoring the SNP Eligibility according to CMS Chapter 2 & 3 Manual for Enrollment and Disenrollment.
- Perform other duties and special projects as requested by supervisors or by the management.
EDUCATION AND EXPERIENCE
- Bachelor’s Degree in business administration or related area preferred.
- Minimum of two years experience in accounting, including complete accounting cycle, reconciliation and development of financial statements or related training.
- Knowledge of Medicare program and/or Medicare+Choice highly desirable.
BENEFITS
- Paid Time Off
- Health Insurance
- Dental/Vision Insurance
- Life Insurance
- 401k
MMM of Florida is an equal opportunity employer. We are committed to providing a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the organization. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives.
As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. We are dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.
