Account Reconciliation Specialist

SSM Health - Madison, WI (30+ days ago)3.7


Role Purpose:
The Account Reconciliation Specialist reconciles accounts on a monthly basis, including employer and government premium accounts, to ensure that premiums and other receivables due are collected and applied to the appropriate accounts, prepares supporting documentation, process write-off adjustments as necessary, and reviews credits and unapplied cash balances. This position monitors and maintains the divisional metrics for aging balance, account reconciliation standards, and timely processing, identifies payment discrepancies and resolves with employer groups and government agencies, as well as research credit balances on customer accounts to determine appropriate action including refund or balance transfer to new account. The Account Reconciliation Specialist works closely with internal departments, external customers, and government or regulatory agencies, to perform reconciliation. Uses appropriate judgment and critical thinking skills in the decision making process.

Essential Job Duties:
1. Review daily cash batches to confirm cash was applied appropriately to accounts as specified by the documentation provided with the payment.

2. Reconcile membership and premiums for Commercial and Government accounts to ensure premiums and other receivables due are collected and membership is accurately reflected.

3. Monitor account discrepancies and follow-up with customers or government agencies regularly to ensure complete and accurate account reconciliations and compliance. Such follow up will be documented to support account status.

4. Analyze the accounts receivable (AR) Aging report. Track and reconcile all customer accounts to the prior month ending balance on the AR aging report. Prepare appropriate documentation to support account reconciliation.

5. Reviews credits and unapplied cash balances. Coordinate with Enrollment & Billing staff to facilitate timely application of credits due.

6. In collaboration with management team members, coordinate the refund process to ensure internal controls are met. Process refund and cash transfers and ensure that former customers with a credit balance receive a timely refund when due meeting internal and compliance standards.

7. Identify and report any discrepancies to the customer in a timely fashion as defined in policies and procedures.

8. Perform final audits of terminated customers to provide final account status.

9. Collaborate with Collections Coordinator or process delinquencies to facilitate collection of delinquent/past due accounts. Work with delinquent accounts to prevent termination of health care coverage for the employer groups who provide coverage to their employees.

10. Review and release ACH premium payments (electronic transfer of funds) to bank. Document control totals for balance and controls. Coordinate with multiple source systems and release files when control totals are validated.

11. Provide exceptional customer service to internal departments, external employer groups and government agencies. Provide back-up support to other staff within the Enrollment & Billing department as needed.

12. Participate in all audits whether internal or external, including Model Audit Rule (MAR). Provide complete and accurate documentation to support all account balances and statuses.

13. Participate in projects and team activities to identify problems and improve work processes and systems.

14. Participate in various projects requiring subject matter expertise

15. Perform other special assignments, as requested.


1. Bachelor's Degree OR Associate Degree and 1 year of relevant experience OR High School Diploma and 3 years of relevant experience. Internal enrollment and billing work experience is highly recommended.

2. High level attention to detail and ability to use appropriate judgement.

3. Ability to collect, organize and analyze information.

4. Strong verbal and written communication skills.

5. Proficient in Microsoft Office, specifically strong Excel skills, with the ability to use/learn company specialized software and hardware.

6. Demonstrated ability to compose clear and accurate routine and non-routine correspondence.

7. Ability to effectively manage multiple tasks, to meet time sensitive deadlines and to organize workload with minimal supervision.

1. Previous experience working in health insurance industry.

2. Knowledge of accounting principles and practices.

3. Eligibility and premium billing experience.

Dean Health Plan, Inc.-

Established in 1983, Dean Health Plan is the insurance services subsidiary of Dean and SSM Health. It maintains a position of leadership in insurance services through a physician-led integrated health system that improves the health of its members and delivers a superior level of service and care. We're looking for talented individuals committed to improving the health of community through innovation, partnership and integrity.