Reconciliation Specialist - Temporary

About SCAN

SCAN Group is a not-for-profit organization dedicated to tackling the most pressing issues facing older adults in the United States. SCAN Group is the sole corporate member of SCAN Health Plan, one of the nation's leading not-for-profit Medicare Advantage plans, serving more than 285,000 members in California, Arizona, Nevada, and Texas. SCAN has been a mission-driven organization dedicated to keeping seniors healthy and independent for more than 40 years and is known throughout the healthcare industry and nationally as a leading expert in senior healthcare. SCAN employees are a group of talented, passionate professionals who are committed to supporting older adults on their aging journey, while also innovating healthcare for seniors everywhere. Employees are provided in-depth training and access to state-of-the-art tools necessary to do their jobs, as well as development and growth opportunities. SCAN takes great pride in recognizing our team members as experts in their fields and rewarding them for their efforts. If you are interested in becoming part of an organization that is innovating senior healthcare visit www.thescangroup.org, www.scanhealthplan.com, or follow us on LinkedIn; Facebook; and Twitter.

The Job

Responsible 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 Will

• 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 Federal, and other regulatory agencies.
• Ensure the incoming and outgoing data is accurate and compliant with the regulatory requirements by documenting process workflows and Policies and Procedures based on State and Federal regulations and requirements.
• 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) received daily, weekly and monthly from regulatory agencies by researching errors, identifying root causes and reporting findings to Management and internal business areas.
• Enter member data by inputting alphabetic and numeric information into ika Systems according to screen format including benefit assignment, group affiliation, provider selection, billing information, revenue codes and appropriate cross references within State and Federal timelines and regulations.
• 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.
• Provide excellent customer services by making a high volume of outbound calls to members to obtain, and or confirm information needed to successfully assess late enrollment penalty, and/or other coverage information for Part D and Part C. The ability to accurately interpret and explain CMS regulations and requirements in person, via email or telephonically
• Prepare eligibility report mailings by generating, reviewing, and distributing eligibility information to other internal and external business departments within defined timelines.
• Prepare member correspondence by creating, triggering, printing, reviewing, and mailing based on State and Federal timelines and regulations
• Complete internal 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, State or Federal entities.
• Research eligibility rejected transactions from both State and Federal entities by identifying discrepancies and report findings to the appropriate business area.
• Oversee enrollment and disenrollment transactions in line with State and Federal regulatory requirements and ensure qualifying documentation is stored within internal system
• Maintain professional and technical knowledge by utilizing access to SCAN University on-line trainings, attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies.
• Actively support the achievement of SCAN's Vision and Goals.
• Other duties as assigned.

Your Qualifications

• 1+ years call center experience
• Experience in Medicare managed care health plan preferred.
• Experience working with ika (Visiant) and/or other healthcare systems preferred.
• Bilingual language skills 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.