JOB SUMMARY:
This Analyst will help to ensure our enrollments are reconciled regularly with our vendor and with the Federally Facilitated Marketplace (FFM). They will review various transactions and reports to ensure the Marketplace enrollment data is in alignment. The work includes reviewing enrollment records on CCOK, CMS and vendor systems and reports. The role is also responsible for submitting corrections as needed.
KEY RESPONSIBILITIES:
- Identifies and resolves discrepancies between CCOK’s system, the vendor’s system, and the FFM’s system.
- Works with vendor to provide analysis of any metrics categories requested by the CMS Account Manager.
- Reviews the Enrollment Alignment Performance Summary Reports (EAPS) to ensure reports are reconciled timely and initiate any necessary corrections.
- Reviews the Pre-Audit files to ensure enrollment data is matching in all systems.
- Reviews Untitled “I” Record (UIR) and makes updates as needed per policy.
- Reviews 1095A Update reports to ensure notification is sent to members whose 1095A form is updated due to enrollment changes.
- Assists internal departments with enrollment issues and questions.
- Maintains compliance with CMS guidelines related to enrollment reconciliation.
- Reviews and updates policies and procedures.
- Other duties as assigned.
QUALIFICATIONS:
- Possess strong oral and written communication skills.
- Ability to read, analyze, and interpret complex reports.
- Strong problem solving & critical thinking skills.
- Ability to work on multiple projects concurrently.
- Proficient in Microsoft and database applications.
- Successful completion of Health Care Sanctions background check.
- Highly organized and attentive to detail.
EDUCATION/EXPERIENCE:
- High school diploma or equivalent.
- Minimum five years of experience in a healthcare related environment preferred.
- Marketplace administration experience preferred.
CommunityCare is an equal opportunity at will employer and does not discriminate against any employee or applicant for employment because of age, race, religion, color, disability, sex, sexual orientation or national origin
