JOB PURPOSE/SUMMARY:

This position is responsible for CenterLight’s billing and revenue cycle to analysis, reconciliation, and operational procedures while maintaining adherence to DOH and CMS guidelines. This position will participate in day-to-day operations (inc. member and provider outreach) and reporting on revenue cycle functions.

JOB RESPONSIBILITIES:

• Perform analytics (on MMR and 820/834) and reconciliation of payments received to billing files.
• Work with the Enrollment/Intake department to investigate and resolve for the purpose of correction/rebilling.
• Identify LTC/Custodial Nursing Home and work with the Clinical team and NH providers to obtain budget letters for the purpose of identifying and collecting NAMI.
• Outreach to Nursing home providers to confirm member eligibility and completion of MAP letter
• Identify members with Surplus, NAMI, or Pool Trust and resolve related issues.
• Outreach Nursing home members with a surplus for collection of the remaining balance and/or potential participation in pool trust.
• Work with the Pharmacy team on monthly PDE reconciliation.
• Work with the Enrollment Intake team to assist with eligibility issues.
• Perform monthly MMR analysis and work with CMS MAPD Helpdesk to open tickets and resolve the issues.
• Work with Dialysis providers to obtain 2728 forms and work with CMS MAPD Helpdesk to open tickets to turn on member ESRD indicator.
• Preparation of monthly GL entry related to revenue and PDE reconciliation
• Assist Actuarial with data analytics as needed.
• Develop financial reporting and analytics in Tableau (including KPI dashboard) that can be used by senior leadership to track actual financial results vs. target and as a tool to identify areas where there is a gap and require attention.
• Prepare ad-hoc financial modeling, analysis, and projections
• Work on special projects as assigned

Schedule: 8:30AM - 5:30PM

Weekly Hours: 40

JOB QUALIFICATIONS: 

Education: 

Bachelor’s degree in Finance or other quantitative disciplines.

Experience:

• 3 years 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 a data source, i.e. MMR, PPR, DTRR, 834/820s.
• Highly organized with an attention to detail. 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):

$62,900.00 - $70,900.00