Job Information
Kelsey-Seybold Clinic Reconciliation Business Analyst in Pearland, Texas
Responsibilities
This role focuses on spotting and reporting different payment and membership errors to CMS and plan delegates promptly and accurately. These discrepancies can range from issues with state and county codes to variations in plan types. It involves validating Annual & Biannual Reporting for both Appeals & Grievances and Enrollment teams, conducting Monthly and Quarterly Data Validation, and reviewing reports to find payment inconsistencies. The job also includes generating, retrieving, and analyzing reports for both internal and external audits, along with fulfilling other data requests. Additionally, this position aids in Appeals & Grievances and Enrollment processes by handling transactions and checking enrollment system updates when necessary.
Job Title: Reconciliation Business Analyst
Location: Pearland Administrative Office
Department: KS Plan Advantage-Operations
Job Type: Full Time
Salary Range: $49,730 - $61,442 (Pay is based on several factors including but not limited to education, work experience, certifications, etc.)
Qualifications
Education
Required: 4 Years of equivalent work experience
Preferred: Associate Degree
Experience
Required: 3-5 years’ experience with Enrollment / Eligibility or in a MA Healthcare Environment.
Demonstrated analytical skills including file format manipulation and data comparison, with demonstrated
knowledge of reconciliation processes, methods, and tools.
Demonstrated knowledge of CMS Regulations and Texas Department of Insurance Regulations including
working knowledge of member complaints, grievance, and appeals processing.
Demonstrated ability to work independently and develop solutions to ongoing issues
Preferred: Demonstrated ability to analyze and report on business units, products, or service lines with
minimal supervision/direction.
Medicare Advantage plan experience preferred.
Demonstrated ability in handling a high case load of complex issues.
Ability to utilize reports to make data driven decisions and monitor universes for accuracy
License(s)
Required: N/A
Preferred: N/A
Special Skills
Required: Experience using Microsoft Excel, Microsoft Word, and a variety of software applications
Preferred: 1 Year TriZetto (EAM) system experience
Other
Required: Fluent in English both verbal and written.
Proven ability to work in fast paced deadline-oriented environment with a high level of accuracy with excellent
attention to detail and work with minimum supervision to meet strict regulatory guidelines.
Superior analytical skills and ability to communicate complex information in a clear and concise manner.
Strong organizational skills and ability to follow through with multiple tasks.
Preferred: N/A
Working Environment: Office
About Us
Start your career journey and become a part of a community of renowned Healthcare professionals. Kelsey-Seybold Clinic is Houston’s fastest growing, multispecialty organization with more than 40 premier locations and over 65 specialties. Our clinics are comprised of more than 600 physicians and as we continue to grow, our focus is providing quality patient care by adding to our team of clinical and non-clinical professionals that work together in a convenient, coordinated, and collaborative manner. Enjoy the rewards of a successful career while maintaining a work/life balance by joining our team today and changing the way health cares.
Why Kelsey-Seybold Clinic?
Medical, Vision, and Dental
Tuition Reimbursement
Company Matching 401K
Employee Reward and Recognition Program
Paid time off for vacation, sick, and holidays
Employee Assistance Program
Continuing Medical Education allowance
Kelsey-Seybold Clinic strives to provide equal opportunity employment without regard to race, color, religion, age, national origin, sex, gender, sexual orientation, gender identity/expression, genetic information, disability, veteran status, or any other basis protected by organizational policy or by federal, state, or local laws unless such distinction is required by law. Kelsey-Seybold is a VEVRAA Federal Contractor and desires priority referrals of protected veterans.
Kelsey-Seybold Clinic
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