JOB PURPOSE:

This position is responsible for Centerlight and its subsidiaries (including MSO clients) accurate and timely delivery of billing, enrollment, revenue, and claims analysis and reconciliation, ensuring the adherence to DOH and CMS guidelines. This position will also participate in day-to-day finance operations (inc. member and provider outreach) and assist on the revenue maximation efforts.

JOB RESPONSIBILITIES:                                     

• Perform membership analysis to determined target members for revenue maximization efforts.
• Perform weekly billing for Centerlight and its subsidiaries (including MSO clients) as well as manage Accounts Receivables. Perform analytics as needed.
• Perform monthly analytics (on MMR and 820/834) and reconciliation of payments received to billing files.
• Perform monthly analytics of claims, including IBNR analysis and reconciliation of claims paid triangle to check registers.
• Coordinate with enrollment the work on the PDE rejections.
• Assist Enrollment team with CMS related issues.
• Coordinate with enrollment MSP letters and corrections of discrepancies in CMS ECRS.
• Work with Enrollment/Intake department to investigate and resolve for the purpose of correction/rebilling.
• Identify LTC/Custodial Nursing Home and work with Clinical team and NH providers to obtain budget letters for the purpose of identifying and collecting of NAMI.
• Identify members with Surplus, NAMI, or Pool Trust and resolve related issues.
• Drive the enrollment process for age-in members for conversion to Medicare (Dual Members).
• Coordinate with Members with Surplus issues and assist with the re-budgeting process with HRA.
• Outreach Nursing home members with surplus for collection of remaining balance and/or potential participation in pooled trust.
• Work with Pharmacy team on monthly PDE reconciliation.
• Work with Enrollment Intake team to assist on eligibility issues.
• Perform monthly MMR analysis and work with CMS MAPD Helpdesk to open tickets and resolve the issues.
• Coordinate with Dialysis providers to obtain 2728 forms and work with CMS MAPD Helpdesk to update member’s ESRD indicator.
• Preparation of monthly GL entry related to revenue and PDE reconciliation.
• Assist the Vice President with audit request to ensure accurate and timely responses.
• Assist Actuarial with data analytics as needed.
• Prepare ad-hoc financial modeling, analysis, and projections.
• Work on special projects as assigned.

Schedule: 8:30AM – 5:30PM

Weekly Hours: 40

QUALIFICATIONS:

Education: Bachelor’s degree in Finance or other quantitative discipline.

Experience:

• 3 year of related work experience in managed care organization/Government Programs (Medicaid and/or Medicare Advantage).
• Industry level knowledge of Medicaid and Medicare rules, regulations, and processes.
• Must have Excel, Access, Visio and PowerPoint skills.
• Experience with big data analytics and reporting tool: SAS, SQL, Tableau, MS Access.
• Experience in using metrics and analytics to quantify goals and results and in presenting information in usable forms.
• Excellent written and verbal communication skills are essential as this position will be interacting with various departments within the company.
• Familiarity with reporting and analytics related to CMS and NY DOH billing and revenue files as data source, i.e. MMR, PPR, DTRR, 834/820s.
• Highly organized with an attention to details. The ability to adapt to and lead change in a business environment is also critical.
• Must be a quick learner and efficient with time sensitive/high pressure deliverables.
• Experience working effectively and influencing others on cross-functional teams.

Physical Requirements

Individuals must be able to sustain specific physical requirements essential to the job. This includes, but is not limited to:

• Standing – duration of up to 6 hours a day
• Sitting/Stationary positions – sedentary position for a duration of up to 6-8 hours a day for consecutive hours/periods.
• Lifting/Push/Pull – up to 50 pounds of equipment, baggage, supplies, and other items used in the job scope using OSHA guidelines, etc.
• Bending/Squatting – have to be able to safely bend or squat to perform the essential functions under the scope of the job.
• Stairs/Steps/Walking/Climbing – must be able to maneuver stairs safely, climb up/down and walk to access work areas.
• Agility/Fine Motor Skills - Must demonstrate agility and fine motor skills to operate and activate equipment, devices, instruments, and tools to complete essential job functions (i.e., typing, use of supplies, equipment, etc.)
• Sight/Visual Requirements – must be able to read documentation, papers, orders, signs, etc., and accurately type/write documentation, etc.
• Audio Hearing and Motor Skills (language) Requirements – must be able to listen attentively and document information from patients, community members, co-workers, clients, providers, etc., and intake information through audio processing with accuracy. In addition, one must be able to speak comfortably and clearly with language and motor skills for customers to understand an individual.
• Cognitive Ability – Must be able to demonstrate good decision-making, reasonableness, cognitive ability, rational processing, and analysis to satisfy essential functions of the job.

Disclaimer: Responsibilities and tasks outlined in this job description are not exhaustive and may change as determined by the needs of the company.

 

We are an affirmative action and equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, disability, age, sexual orientation, gender identity, national origin, veteran status, height, weight, or genetic information. We are committed to providing access, equal opportunity, and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities.

Salary Range (Min-Max):

$85,000.00 - $95,000.00