Job: Operations Analyst (Billing and Reconciliation)

Location: New York, NY

JOB SUMMARY:

The Operations Analyst will be responsible for analyzing data for the Billing Unit for all Member Service Operations (MSO) and Qualified Health Plans (QHP) product. This position will deal with revenue from the state and reconciling payment against membership. The individual will be responsible for generating member correspondences. The Operations Analyst will be in charge of ensuring Data Warehouse (DWH) has been accurately updated. They will generate a monthly report to summarize the activity of the prior month's enrollment, billing, collections.

Responsibilities:

• Responsible for reconciliation of billing and payment received by NY State, Federal (QHP) and Members. Will load the reports in Data Warehouse (DWH) and generate monthly reports on the analysis performed.
• Generate the correspondence letters for members who need to Binder letter reminders/Warning letters, Delinquency letters, Termination letters and Cancelation letters.
• Generate member billing files to confirm all active members with premium responsibilities are billed correctly.
• Maintain accurate record of individual member account balance.
• Generate the member disenrollment for non payment and reinstatement reports. The reports will be provided to the Enrollment team and updates inputted into MHS.
• Identify potential refund for qualifying members. Generate a monthly refund report.

Minimum Qualifications:

• Associates degree or High School Diploma/GED and 2 years of relevant work experience.
• Must be able to manipulate and create Excel spreadsheets; which will include standardizing reports, utilizing vLookups, pivot tables, filtering and formulas to generate desired results.
• Must be familiar with Access as a database management system.
• Must have experience with data mining, report analysis or reconciliation in a healthcare billing or commercial insurance environment.
• Experience analyzing premium records and remittance payments received.
• Ability to provide analysis support for premium adjustments to financial statements as needed.
• Must be able to work efficiently in a fast paced environment.

Preferred Qualifications:

• Bachelor's degree.
• Any programing experience, knowledge of SAS or SQL.
• Departmental and interdepartmental interaction with Enrollment, Finance and IT teams; any prior experience collaborating on such projects.
• Familiarity with PHSP (Medicaid, Child Health Plus) products.

*LI-NC1

Apply Here

PI69669931 

More Info and Application