Healthfirst

The Enrollment & Billing (E&B) Reconciliation & Recovery Analyst ensures member data is accurate so eligible Healthfirst members’ premium collection from the State is completed in a timely manner. The incumbent also supports various activities within E&B aimed at minimizing future audit findings by identifying and resolving inconsistencies between Healthfirst, NY State of Health (NYSoH), Department of Health (DOH) and Centers for Medicare & Medicaid Services (CMS). Job Description

• Operate with intellectual curiosity and critically assess existing processes and procedures to identify opportunities for improvement
• Summarize and present data outcomes, recommendations, and methodology to Reconciliation and Recovery leadership, E&B leadership, and enterprise stakeholders
• Analyze large data sets and identify patterns within the defined population to organize the backlog, determine outliers and identify root-causes of membership, payment, or other data discrepancies
• Determine short and long-term actions to resolve current cases of membership/ payment discrepancies and new ones from reoccurring
• Understand, validate, and document the business rule(s) to flag membership for reconciliation and/ or premium recovery for a defined population
• Liaison between department leaders, subject matter experts, Healthfirst finance, etc.
• Establish job-aids to enable user-correction of membership errors and/or submission of information to the DOH and NYSoH
• Work with outsourced vendors to enable them to resolve cases flagged for manual correction
• Partner with the Quality Assurance (QA) team to develop a QA model to ensure quality, compliance and regulatory standards are met
• Work collaboratively across the department and organization to share best-practices and coordinate corrective actions applicable to other populations
• Establish tracking mechanism to track effectiveness and data accuracy within the defined population and report results to senior leadership
• Other duties as assigned

Minimum Qualifications:

• Bachelor’s degree from an accredited institution (or GED/High School diploma from accredited institution with relevant work experience)
• Working experience exhibiting strong critical thinking and analytical skills
• Familiarity with the data lifecycle within the organization and its impact on the business
• Experience working in a team-oriented, collaborative environment
• Work experience requiring effective communication verbally and in writing while demonstrating good grammar, spelling, and punctuation skills    

Preferred Qualifications:                                                         

• Degree in Mathematics, Computer Science, Data Sciences, Engineering, Business Analytics, Informatics, or similar concentration
• Familiarity with statistical principles, such as standard deviations, normal distributions, and regressions
• Familiarity with healthcare data, especially enrollment data
• Ability to work effectively with both business and technical stakeholders

Hiring Range*:

• Greater New York City Area (NY, NJ, CT residents): $68,900 - $99,620

• All Other Locations (within approved locations): $61,300 - $91,120

As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.

In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.

*The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified.