Reconciliation Business Analyst

Responsibilities

This role focuses on spotting and reporting different payment and membership errors to CMS and plan delegates promptly and accurately. These discrepancies can range from issues with state and county codes to variations in plan types. It involves validating Annual & Biannual Reporting for both Appeals & Grievances and Enrollment teams, conducting Monthly and Quarterly Data Validation, and reviewing reports to find payment inconsistencies. The job also includes generating, retrieving, and analyzing reports for both internal and external audits, along with fulfilling other data requests. Additionally, this position aids in Appeals & Grievances and Enrollment processes by handling transactions and checking enrollment system updates when necessary.

Job Title: Reconciliation Business Analyst

Location: Pearland Administrative Office

Department: KS Plan Advantage-Operations

Job Type: Full Time

Salary Range: $49,730 - $61,442 (Pay is based on several factors including but not limited to education, work experience, certifications, etc.)

Qualifications

Education

Required: 4 Years of equivalent work experience

Preferred: Associate Degree

Experience

Required: 3-5 years' experience with Enrollment / Eligibility or in a MA Healthcare Environment.

Demonstrated analytical skills including file format manipulation and data comparison, with demonstrated

knowledge of reconciliation processes, methods, and tools.

Demonstrated knowledge of CMS Regulations and Texas Department of Insurance Regulations including

working knowledge of member complaints, grievance, and appeals processing.

Demonstrated ability to work independently and develop solutions to ongoing issues

Preferred: Demonstrated ability to analyze and report on business units, products, or service lines with

minimal supervision/direction.

Medicare Advantage plan experience preferred.

Demonstrated ability in handling a high case load of complex issues.

Ability to utilize reports to make data driven decisions and monitor universes for accuracy

License(s)

Required: N/A

Preferred: N/A

Special Skills

Required: Experience using Microsoft Excel, Microsoft Word, and a variety of software applications

Preferred: 1 Year TriZetto (EAM) system experience

Other

Required: Fluent in English both verbal and written.

Proven ability to work in fast paced deadline-oriented environment with a high level of accuracy with excellent

attention to detail and work with minimum supervision to meet strict regulatory guidelines.

Superior analytical skills and ability to communicate complex information in a clear and concise manner.

Strong organizational skills and ability to follow through with multiple tasks.

Preferred: N/A

Working Environment: Office

About Us

Start your career journey and become a part of a community of renowned Healthcare professionals. Kelsey-Seybold Clinic is Houston's fastest growing, multispecialty organization with more than 40 premier locations and over 65 specialties. Our clinics are comprised of more than 600 physicians and as we continue to grow, our focus is providing quality patient care by adding to our team of clinical and non-clinical professionals that work together in a convenient, coordinated, and collaborative manner. Enjoy the rewards of a successful career while maintaining a work/life balance by joining our team today and changing the way health cares.

Why Kelsey-Seybold Clinic?

• Medical, Vision, and Dental

• Tuition Reimbursement

• Company Matching 401K

• Employee Reward and Recognition Program

• Paid time off for vacation, sick, and holidays

• Employee Assistance Program

• Continuing Medical Education allowance

Kelsey-Seybold Clinic strives to provide equal opportunity employment without regard to race, color, religion, age, national origin, sex, gender, sexual orientation, gender identity/expression, genetic information, disability, veteran status, or any other basis protected by organizational policy or by federal, state, or local laws unless such distinction is required by law. Kelsey-Seybold is a VEVRAA Federal Contractor and desires priority referrals of protected veterans.