: Membership Operations Reconciliation Specialist

A bit about us:

Were on a mission to change healthcare how its paid for, delivered, experienced. We want to put people center stage, not process or profit. We are guided by a deep belief that every person on Medicare should be treated like we would treat a member of our own family: with loving care and a profound commitment to their health and well-being.

Thats why were gathering a whole bunch of smart, big-hearted people to create a new kind of healthcare company one that combines compassion, health insurance, clinical care, and technology seamlessly.

We want to throw the long ball with people we love for a cause we believe in. Life is short. Join us.

A bit more about this role:

The Membership Operations Reconciliation specialist works collaboratively with the team to execute the day-to-day business processes required to support the delivery of critical health services: enrollment, membership maintenance, and financial transactions impacting Devoted Health members. In this role, you will demonstrate compliance with the Center for Medicare and Medicaid Services guidance, Devoted Health policy and Membership Operations procedures/protocols.

As Membership Operations Reconciliation Specialist, you will collaborate with designated staff from Devoted Product, Engineering, Data Science and Integration teams to develop and enhance solutions to improve processes. As well, you will directly support our internal partners: Marketing, Agent Support, Telesales, Guides, Claims, Provider, Pharmacy, Risk Adjustment and Finance.

Responsibilities will include:

  • Create transparency into plan premium revenue, accounts receivable and CMS revenue reconciliation.
  • Compare plan membership files with Centers for Medicare and Medicaid Services (CMS) reports identifying discrepancies monthly.
  • Research and interpret errors identified to ensure accurate membership payments.
  • Prepare a monthly Enrollment and Payment Reconciliation report for the organization.
  • Present and articulate findings to the Finance Department, responsible for attesting quarterly to Centers for Medicare and Medicaid Services (CMS).
  • Oversee internal and external audits, including but not limited to: research, case creation, submission and corrective action implementation.
  • Integrate process improvements through monthly reconciliation, to ensure membership, enrollment and payment data is accurate and aligned with Centers for Medicare and Medicaid Services (CMS).
  • Provide accurate and thorough written responses to inquiries.
  • Ensure the integrity of membership data.

Attributes to success:

  • Comprehensive root-cause analytic skills and a knack for tearing apart problems
  • Highly organized
  • Enthusiastic about helping others, meeting challenges and effectively participating in group settings
  • Team player attitude with the willingness to take initiatives to troubleshoot Compliance-driven; works well in a fast-paced environment with firm deliverables and timeframes
  • Quick learner and adaptable to change in a fast-paced, rapidly changing environment
  • Curiosity to recognize process deficiencies, recommend improvements and implement solutions.
  • Flexibility and willingness to change according to business needs
  • Comfortable working both individually and team settings
  • Enthusiastic about helping others, meeting challenges and effectively participating in group settings
  • Compassion for healthcare challenges facing the Medicare population
  • Ability to accommodate overtime and/or a rotating schedule in accordance with work volume demands.

Desired skills and experience:

  • Ability to work in a startup, fast paced environment
  • Bachelors degree in Finance, Statistics, Mathematics, Data Analysis, Health Science
  • 2+ years of relevant experience
  • Knowledge of, or willingness to quickly absorb, Medicare guidance
  • Demonstrate the ability to achieve short term goals in 4-6 week intervals
  • Detail Oriented with excellent written, spoken communication and problem-solving skills
  • Proficient in spreadsheets; ability to navigate the Google Suites platforms
  • Experience using SQL to identify trends, present and analyze raw data. Not required but preferred

Healthcare equality is at the center of Devoteds mission to treat our members like family. We are committed to a diverse and vibrant workforce. If you lack a specific credential for this position but believe that your strengths and life experiences will propel our mission, we would love to hear from you.

If you love running towards complex challenges and transforming them into solutions, if you want to make a potentially huge impact on many lives, and if you are looking for a disruptive startup with an inspiring and talented team, Devoted Health may be the place for you!

Devoted is an equal opportunity employer. We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoteds Code of Conduct, our company values and the way we do business.

As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.