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Revenue Analyst - Senior Products Membership Accounting

Company: TalentBoost (Point32Health)
Location: Fall River
Posted on: January 25, 2023

Job Description:

Under the general supervision of the Supervisor, Membership Accounting, the responsibilities for this position will primarily be the development and refinement of the analysis and reconciliation for MSP, LIS, ESRD, Hospice and SCO to ensure compliance with all CMS and State regulations on internal department processes while supporting the product offerings. This individual will demonstrate the ability to follow business processes and consider options when problems arise and consistently perform routine daily deliverables independently.This includes analysis of data contained within CMS files, perform root cause analysis to resolve discrepancies, generate and distribute revenue reporting based on departmental protocols with an emphasis on MSP reporting. This individual must be able to plan, organize, and prioritize work to ensure completion in a timely manner. This individual must demonstrate an ability to follow business processes, to consider options when problems arise, and to identify and escalate issues appropriately. This individual is expected to learn and understand department processes and their inter dependencies, contribute to process enhancement opportunities, and support Medicare Preferred and departmental objectives.Key Responsibilities/Duties- what you will be doing

  • Expand knowledge of the monthly payments received by CMS
  • Update daily/monthly records received from CMS in all systems accordingly to match each other and to match CMS..
  • Review/research data rejects
  • Adjust member records and set sequences in Market Prominence (MP), Diamond, and HealthRules Payor (HRP) - Special Status Beneficiaries
  • Work MSP (Medicare Secondary Payor) records, ensuring letters are sent to members timely, that incoming mail is completed quickly while updating in CMS system the responses from members. Work with Claims department to ensure updates affecting a member's claims are completed timely and accurately.Qualifications - what you need to perform the jobEDUCATION, CERTIFICATION AND LICENSURE:
    • Associates degree in Business; Bachelors preferred
    • 1-4 years related business experience
    • Financial background a plusSKILL REQUIREMENTS:
      • Intermediate database and Excel skills a must
      • Demonstrated ability to manage tasks independently, take ownership of responsibilities and meet deadlines
      • Strong written and oral communication skills
      • Significant MS Office skills, with focus on Excel and Access at intermediate/advanced level.
      • Solid communication skills (effective verbal and written skills).
      • Strong organizational and time management skills.
      • Demonstrate flexibility, commitment, and resiliency in times of business and organizational change
      • Demonstrate professional demeanor at all times
      • Support collaboration across Membership Operations and other departments and work cooperatively as a team member.
      • Provide/accept constructive criticism for improvement, including peer and supervisor feedback for performance management. Coach others to do so.WORKING CONDITIONS AND ADDITIONAL REQUIREMENTS (include special requirements, e.g., lifting, travel):
        • This is a hybrid position requiring weekly in office 2-3 days.
        • Must be able to work under normal office conditions and work from home as required
        • Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations.
        • May be required to work additional hours beyond standard work schedule
          Commitment to Diversity, Equity & InclusionPoint32Health is committed to making diversity, equity, and inclusion part of everything we do-from product design to the workforce driving that innovation. Our DEI strategy is deeply connected to our core values and will evolve as the changing nature of work shifts. Programming, events, and an inclusion infrastructure play a role in how we spread cultural awareness, train people leaders on engaging with their teams and provide parameters on how to recruit and retain talented and dynamic talent. We welcome all applicants and qualified individuals, who will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.COVID PolicyPlease note: As of January 18, 2022, all employees - including remote employees - must be fully vaccinated. This position will require the successful candidate to show proof of full vaccination against COVID-19. Point32Health is an equal opportunity employer, and will consider reasonable accommodation to those individuals who are unable to be vaccinated consistent with federal, state, and local law.About the CompanyPoint32Health is a leading health and wellbeing organization, delivering an ever-better personalized health care experience to everyone in our communities. At Point32Health, we are building on the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care, where we leverage our experience and expertise to help people find their version of healthier living through a broad range of health plans and tools that make navigating health and wellbeing easier.We enjoy the important work we do every day in service to our members, partners, colleagues and communities.This job has been posted by TalentBoost on behalf of Point32Health. TalentBoost is committed to the fundamental principle of equal opportunity and equal treatment for every prospective and current employee. It is the policy of TalentBoost not to discriminate based on race, color, national or ethnic origin, ancestry, age, religion, creed, disability, sex and gender, sexual orientation, gender identity and/or expression, military or veteran status, or any other characteristic protected under applicable federal, state or local law.Req ID:R5816

Keywords: TalentBoost (Point32Health), Fall River , Revenue Analyst - Senior Products Membership Accounting, Professions , Fall River, Massachusetts

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