Description :

1. Reviewing identified discrepancies between the information within the Medicare services platform and the monthly files from government agencies and client systems including but not limited to the Centers for Medicare and Medicaid Services (CMS) full file, the payments withholding report and the claim processor reconciliation files.
2. Taking appropriate action, based on the discrepancy, to correct the information in the system identified as being incorrect and trigger any communication necessary based on the resolution.
3. Taking all steps required by departmental policies to process cms transactions that do not automatically process including, but not limited to, updating customer accounts, updating client systems and triggering customer communication.
4. Identifying the need for outbound calls for purposes of validating information and addresses and conducts member outreach.
5. Responsible for compliance with all federal, state and local laws, rules and regulations affecting the company.
6. Responsible for participating in quality assurance, compliance and in-service and continuing education activities as requested by the company.
7. Effectively ensuring updates on any changes and/or adjustments to any rules, policies and/or responsibilities as needed.

Experience

10+ Years

Level

Consultant

Education

Certification

Description :

1. Defining the business rules and set a process for reconciliation.
2. Ensuring all transaction are reconciled with payment gateways at the transaction level and accounting level.
3. Ensuring all transaction is reconciled with clients at the transaction level and accounting level.
4. Ensuring all receipts via all mode of payments from wallet partners on a particular day are investigated and reconciled within the time allotted.
5. Ensuring anything suspicious or out of ordinary is escalated to the Manager without any delay.
6. Identifying the business knowledge gaps and ensuring everyone has ownership of deliverables.
7. Ensuring none of the critical tasks to be completed for the day are missing.
8. Coordinating with various internal departments to resolve issues
9. Ensuring the timely sign off for monthly and quarterly reporting cycles.

Experience

5-7 Years

Level

Executive

Education

BS

Description :

1. Processing of all deposits received on a daily basis for multiple medical practices including paper and electronic payments and correspondence from the client’s bank.
2. Facilitating reconciliation between bank deposits, remittance received, and payments applied to the practice management system.
3. Documenting the root cause and discrepancies and generating the reports based on department protocols.
4. Documenting the results of research and amends appropriate systems as required to reconcile payments.
5. Identifying trends in improved internal processes, systems, etc. as needed.
6. Conforming to the defined platform, client, payer, and/or internal standard operating procedures (sops) and/or other applicable guidelines and regulations in completing job duties.
7. Ensuring all workflow items are completed within the set turn-around-time within quality expectations.

Experience

7-10 Years

Level

Senior

Education

High School

Description :

1. Ensured database and system integrity by reconciling daily transactions submitted to update counts for handheld/ handwritten tickets and payments including cashiering location, DMV, lockbox, phone, and web.
2. Conducted research for any variances and for all rejected transactions by coordinating with the Tarrytown data center and local systems analyst.
3. Maintained and submitted monthly statistical reports to the various contract and department managers.
4. Performed quality assurance on all outgoing notices generated by the system.
5. Prepared source data for computer entry by compiling and sorting information, establishing entry priorities.
6. Maintained operations by following policies and procedures, reporting needed changes.
7. Collaborated with fund administrators to provide financial statements, fund due diligence.

Experience

7-10 Years

Level

Senior

Education

Diploma

Description :

1. Analyzing reconciliations to identify potential financial risk to the bank.
2. Ensuring that the reconcilers adhere to compliance rules and achieve resolutions to all breaks in a timely manner.
3. Escalating large unidentified amounts to upper management that may cause a loss to the bank.
4. Confirming the accuracy of the potential balance sheet write-offs before sending final numbers to upper management.
5. Responsible for extracting general ledger data and analyzing which accounts will be automated into reconciliation system, frontier (Fiserv product).
6. Meeting with all bank departments to ensure each department's general balance is accurate.
7. Auditing the reconciler's work on a monthly basis to ensure reconciliations are correct.
8. Consolidating large amounts of data into summaries for the Controller and the Assistant Controller for month closing.
9. Additional month end closing support include journal entries, processing write-offs, analyzing discrepancies in balance sheet accounts.

Experience

2-5 Years

Level

Junior

Education

BS

Description :

1. Identifying problems and developing solutions for all areas in connection.
2. Developing business specifications and liaising with developers in refining the departmental/management consensus for automation methods and strategies as well as the development of infrastructure for metric reporting and user requests.
3. Determining whether to settle cases and/or appeals based on low income, and other facts or setup defense packs for in-house attorneys.
4. Comprehensive knowledge and understanding of working within federal and state regulations to ensure that business processes adhere to them.
5. Responsible for generating reports to quantify the exposure of the entire balance sheet to interest rate risk, liquidity risk, and other market risks.
6. Maintaining accurate records and establishing the strong working relationships with all business lines and accounting groups.

Experience

10+ Years

Level

Consultant

Education

BS

Description :

1. Reviewed and interpreted the tenant or land agreements for key business terms required to generate tenant billing or land payments, recorded the appropriate financials.
2. Stayed informed of current company practices and guidelines, including straight line rules, master lease governance, and commencement date determination, to administer lease documents appropriately in oracle system.
3. Ability to communicate effectively and efficiently high-risk discrepancies that were identified to the management (i.e. Early detection, trend identification).
4. Utilized lease audit documentation to ensure audits take into consideration using company guidelines related to lease data including but not limited to master lease agreement stipulations, straight line (fas13) status and dates, and commencement date determination.
5. Abstracted the lease information including but not limited to rental amounts, terms, escalations, obligations, straight line and commencement dates into universal audit form and run match report to identify incorrect data.
6. Administered calculations of revenue share payments, government fees, property taxes, or other obligations related to tenant or land leases.
7. Interacted with internal auditors and the finance department in occasional auditing projects or provide information that supports current business initiatives.

Experience

10+ Years

Level

Management

Education

Business Management

Description :

1. Worked directly with other departments such as document processing, clients services, and management resolving customer accounts.
2. Researched, analyzed, and updated all required materials needed for each Medicare account for the organization as well as overseeing and verifying that all changes in the system are reconciled on a regular basis.
3. Responsible to participate in quality assurance, compliance, and continuing education activities as requested by company.
4. Reconciled all incoming medicare transaction reply codes within the given medicare time frame thoroughly researched a response to Medicare.
5. Familiar with database Marx medicare advantage and prescription drug system.
6. Analyzed departmental documents for appropriate distribution and filing.
7. Entered numerical data into databases in a timely and accurate manner.
8. Outlined the appropriate process and procedures necessary to fulfill and complete inquiries.

Experience

2-5 Years

Level

Junior

Education

BS

Description :

1. Analyzing the daily summary reporting of received and processed enrollment transactions from the exchanges to identify discrepancies and ensure receipt of all transactions.
2. Maintaining the regulatory updates and report rollout to departments impacted.
3. Identifying, analyzing the root cause of discrepancies between enrollment/eligibility files (834 transactions) and payment files (820 transactions) using strong problem-solving skills.
4. Performing audits from all resources and cross-functional departments where applicable to resolve discrepancies.
5. Communicating 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.
6. Preparing the adequate documentation to validate the capitation and administrative fee.
7. Preparing journal entries and initiating the wire transfers to balance bank and ledger records.

Experience

10+ Years

Level

Consultant

Education

Diploma

Description :

1. Resolving the discrepancies or variances found by working with vendors and internal personnel to ensure that recurring charges are correct and customers are billing appropriately.
2. Monitoring and control processing gaps, creating step action procedures as needed and effectively communicate with cross-functional teams such which include the federal and state exchanges and issuer clients as to the course of action needed for resolution.
3. Researching and reconciling the accounting system against the custody systems for both cash and securities.
4. Reconciling bank accounts including the return of funds, trade accounts, and loans.
5. Handling the Excel daily in order to reconcile manual accounts.
6. Collecting the data from all resources and cross-functional departments where applicable to resolve discrepancies, while ensuring compliance is met with federal and state regulations.
7. Performing the daily working of membership data discrepancies between the healthcare carriers and health plan services.

Experience

5-7 Years

Level

Executive

Education

BS