Reconciliation Specialist, South San Francisco, CA
The Health Plan of San Mateo (HPSM), a managed care health plan, seeks a full time Reconciliation Specialist to perform quality analysis of HPSM’s member data through the review of CMS Medicare and DHCS Medi-Cal eligibility files and reports to ensure integrity and accuracy of member records and appropriate capitation payment. The essential duties and responsibilities will include the following:
- Analyze reports that compare member-specific enrollment data between the HPSM eligibility system and Medicare/ Medi-Cal eligibility and payment files to identify any discrepancies.
- Ensure that member-specific data indicators are accurately reflected on CMS Medicare and/or DHCS Medi-Cal eligibility and payment files.
- Prepare enrollment and other reports from internal and external sources to perform review and analysis.
- Prepare reports of inaccurate member-specific data which clearly identifies the data indicators requiring correction.
- Develop working relationships with CMS, DHCS and/or Human Services Agency staff responsible for updating member eligibility records.
- Maintain accurate tracking logs and submit member records for correction to appropriate CMS, DHCS and/or Human Services Agency staff.
- Continuously monitor member records and enrollment and payment reports to ensure that corrections have been appropriately processed and HPSM has received appropriate payment.
- Document process work flows and policies and procedures.
- Professionally represent Plan and Department in internal and external meetings.
Education and Experience: A college degree in a health or business related field preferred. Four (4) years of experience in Medicare and/or Medi-Cal managed care enrollment, disenrollment and/or Medi-Cal eligibility.
Knowledge of: Medicare, Medi-Cal and Managed Care, including eligibility requirements. Methods of report preparation, writing and presentation. Database maintenance. Personal computers and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, Access and PowerPoint.
Ability to: Manage projects; prioritize/organize workload. Perform highly advanced research, use analytical skills in problem identification and resolution, and effectively influence positive outcomes. Prepare clear and concise reports. Achieve high degree of accuracy on all reports and analysis and possess excellent attention to detail. Use initiative; work independently using sound judgement.
Starting Compensation: Between $ 23.09 – $31.75 per hour - depending on experience.
Benefits Information: HPSM offers extremely competitive benefits. Check them out at: https://www.hpsm.org/abouthpsm/employment-opportunities.aspx (Under Employee Benefits Tab)
Application Process: To apply, submit a resume and cover letter with salary expectations to: Health Plan of San Mateo, Human Resources Department, 801 Gateway Blvd., Suite 100, South San Francisco, CA 94080 or via email: firstname.lastname@example.org or via fax: (650) 616-8039. File by: Open until Filled. EOE