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Reconciliation Specialist

Company: SCAN Health Plan
Location: Long Beach
Posted on: May 12, 2022

Job Description:

As one of the nation's largest not-for-profit Medicare Advantage plans, serving more than 200,000 members in California, SCAN Health Plan has been a mission-driven organization dedicated to keeping seniors healthy and independent for over 40 years. SCAN employees are passionate about what they do, and understand that success is based on achieving the mission. Employees are afforded with the training and tools necessary to do their jobs and are rewarded for their efforts and recognized as experts in their fields. To learn more, visit scanhealthplan.com or follow us on social media: LinkedIn ; Facebook ; and Twitter . The jobResponsible to resolve discrepancies and prepare eligibility related findings to Analyst Team and/or management. To minimize discrepancies and identify and investigate member data between plan membership systems and Medicare by reconciling, entering, correcting, tracking, monitoring, and deleting member information as necessitated to maintain accurate records.You

  • Identify and respond to information requests from internal business areas, external vendors, and regulatory agencies by participating in process design sessions and reviewing enrollment data reports from CMS, and other regulatory agencies.
  • Ensure the incoming and outgoing data is accurate and compliant with the regulatory requirements by documenting process work flows and Policies and Procedures.
  • Generate enrollment data files, QA the files with other departments, and submit to regulatory agencies by working with the Analyst staff to automate and establish reconciliation procedures.
  • Coordinate the resolution of all rejected transactions (i.e. Eligibility PDE and Encounter Rejects) from regulatory agencies by researching errors, identifying root causes and reporting findings to Management and internal business areas.
  • Process member applications by reviewing data for deficiencies; assigning codes to data; establishing data entry priorities, and resolving discrepancies by using departmental policies and procedures
  • Enter member data by inputting alphabetic and numeric information into ika (Visiant) Systems according to screen format including benefit assignment, group affiliation, provider selection, billing information, revenue codes and appropriate cross references.
  • Verify entered data by reviewing, correcting or updating data assisting in the regulatory submission and reply transactions.
  • Verify eligibility for enrollment using state and federal websites.
  • Prepare eligibility report mailings by generating, reviewing and distributing eligibility information to providers within defined timelines.
  • Prepare member correspondence, including member letters, by printing, reviewing and mailing.
  • Complete requests and provide information by answering questions and inquiries, by professionally representing the department to others, referring inquires; generating telephone or written responses to inquiries.
  • Assure accurate data from regulatory system reply by utilizing departmental systems to run reports and collect and analyze data.
  • Bring discrepancies, between member data and various systems, to a resolution by corresponding with member or federal entities.Required: G.E.D / High School
    • 1+ years Call Center experience.
    • Experience in Medicare managed care health plan preferred.
    • Experience working with ika (Visiant) and/or other healthcare systems preferred.
    • Extensive simultaneous computer and telephone usage.
    • Strong interpersonal skills, including excellent written and verbal communication skills.
    • Strong organizational skills; Ability to multitask.
    • Ability to appropriately maintain confidentiality.
    • Strong analytical and critical thinking skills, required.
    • Proficiency in a second language required (includes, but not limited to, Korean, Spanish, Tagalog, Cantonese, Mandarin, Vietnamese, Farsi, and Russian).What's in it for you?
      • A competitive compensation and benefits program -
      • An annual employee bonus program
      • Robust Wellness Program
      • Generous paid-time-off (PTO)
      • Ten paid holidays per year, plus 1 additional floating holiday
      • Excellent 403(b) Retirement Saving Plan with employer match
      • Robust employee recognition program
      • A work-life balance
      • An opportunity to become part of a team that makes a difference to our members and our community every day!To ensure a healthy and safe work environment, if you are selected for this position, your job offer with SCAN Health will be contingent upon being fully vaccinated and providing proof of your COVID-19 vaccine within 3 days after your start date. Generally, you are considered fully vaccinated 14 days after receiving the last dose, as recommended by the manufacturer, of a vaccine that has been authorized by the FDA for use in the United States, including vaccinations that have been approved pursuant to an Emergency Use Authorization. If fully vaccinated outside of the United States, the vaccination must be listed for emergency use by the World Health Organization (WHO). If you cannot receive the vaccine because of a disability/medical reason or sincerely-held religious belief, you may request an accommodation to this requirement by contacting -COVID-19 Vaccination Policy . Learn more about the COVID-19 vaccination here - -https://www.cdc.gov/coronavirus/2019-ncov/vaccines/index.html We're always looking for talented people to join our team! Qualified applicants are encouraged to apply now!At SCAN we believe that it is our business to improve the state of our world. Each of us has a responsibility to drive Equality in our communities and workplaces. We are committed to creating a workforce that reflects our community through inclusive programs and initiatives such as equal pay, employee resource groups, inclusive benefits, and more. -SCAN is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required. #LI-JR1QualificationsSkillsBehaviors: Motivations:EducationExperienceLicenses & CertificationsEqual Opportunity Employer/Protected Veterans/Individuals with DisabilitiesThe contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c) Keeping Seniors Healthy and Independent

Keywords: SCAN Health Plan, Long Beach , Reconciliation Specialist, Other , Long Beach, California

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