RECONCILIATION SPECIALIST in CANTON, Ohio at Aultman Health Foundation

PURPOSE OF POSITION:

The primary purpose of the PTHP Reconciliation Specialist is to reconcile and validate the CMS (Centers for Medicare & Medicaid Services) reports with our member records. They are responsible for meeting or exceeding turnaround time standard and quality expectations of Medicare Part C and D adjustments/reconciliations in accordance with service level agreements, standard operating procedures, financial and governmental regulations across all processing platforms. This position works closely with the PTHP Eligibility Supervisor to maintain an efficient department.

OTHER RESPONSIBILITIES & EXPECTATIONS:

• Assures that our enrollment system (EAM) is in sync with the CMS system for members.
• Validates that the Part C enrollment is loaded properly from our enrollment system (EAM) to our operating system (QNXT).
• Reviews and completes reporting on a daily, weekly, and monthly basis to reconcile enrollment.
• Formats and maintains model letters.
• Assists in supplemental training for colleagues in the department.
• Special projects as determined.
• Lead Tester in system for other areas and EAM/QNXT upgrades.
• Must be a Role model / Example in unit.
• Must be fair and consistent with all employees.
• Possess leadership qualities / be a resource to department.
• Process Improvement: Continuously reviews, recommends and implements improvement steps, as needed or directed.
• Seeks supervisory guidance/approval as appropriate.
• Subject to frequent interruptions and must be able to timely prioritize workflow for themselves and the department.
• Portrays professional image: follows dress code; communicates with internal and external customers in a professional manner, including appropriate verbal and written grammar.
• Promotes and demonstrates professional standards to enhance the development of the department.
• Practices ethical conduct.
• Meets acceptable attendance and punctuality expectations (excluding FMLA).

The above statements reflect the general duties considered necessary to describe the principal functions of the job as identified, and is not a detailed description of all the work requirements that may be inherent to this position.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, sexual orientation, age, national origin, disability, or protected veteran status. AultCare is an EEO/AA Employer M/F/Disability/Vet.

AultCare/AHF will provide reasonable accommodations to employees or applicants with disabilities, as defined by the Americans with Disabilities Act, who are otherwise qualified to safely perform the essential functions of the job, with or without accommodation, unless such accommodation would constitute an undue hardship on AultCare/AHF or poses a direct threat to the health and safety of the individual or others that cannot be sufficiently mitigated by reasonable accommodation. Any applicant or employee who requires an accommodation to perform the essential functions of his or her job or to enjoy equal benefits and privileges of employment should notify the AultCare Human Resource Department and request such an accommodation.

QUALIFICATIONS:

• Education: High School Graduate required. College credits or two years comparable experience is preferred.
• Experience: Good typing skills and working knowledge of Word, Excel and Ten Key Number Pad.
• Functions independently with flexibility, integrity and the ability to work effectively and efficiently with all levels of personnel.
• Must be able to deal with confidential information and keep it confidential.

WORKING CONDITIONS:

• Office environment with moderate noise level.
• Frequent sitting, use of hands/fingers across keyboard or mouse, and long periods working at a computer.
• Occasionally walking, standing, twisting/turning and reaching upward or forward during workday.