Medicare Reconciliation Specialist

Minneapolis, Minnesota
Mar 26, 2013
Apr 01, 2013
Employment Status
Full Time

Health Care that Starts with You!

Join a truly mission-driven organization! Independent, nonprofit UCare is recognized as one of the Minnesota???s leading health plans. We provide more than 225,000 members across Minnesota and western Wisconsin with the health coverage plans and services they need to maintain and improve their health. The innovative coverage we create makes a difference for Medicare-eligible individuals, individuals and families enrolled in Minnesota Health Care Programs, such as MinnesotaCare and Medical Assistance, and disabled adults with special health care needs. UCare is growing in size, membership, products, geographic coverage, and employees. We???re an organization that???s going places. Be part of a team that cares about you, be part of UCare.

As a Medicare Reconciliation Specialist, you will perform detail analysis of the various elements of UCare’s CMS enrollment/revenues for the Minnesota and Wisconsin Medicare and dual products. Analysis consists of comparing information contained in UCare’s core operating systems to information provided by CMS (Center of Medicare/Medicaid Services). This position is responsible for the letter identification, accounting and reporting related to the tasks performed, as well as working with the Enrollment department to resolve and clear differences noted. Specific duties and responsibilities include:

  • Perform reconciliations of CMS enrollment (Part C and Part D) for MN and WI Medicare and Ucare dual products. Includes analysis and tracking differences identified on the TRR reports, finalize spreadsheet for mail merge for all required member correspondence.  Review AMISYS upload to ensure accuracy and analyze the error reports ensuring that all retroactive activity is entered into AMISYS.
  • Work with Enrollment to resolve enrollment differences issues, including Doc Triage, FIR transactions, Auto/Facilitated process, Audit/Exception reports and various queues as assigned. Assist with development, implementation, and managing the processes for identifying and tracking LEP for Medicare beneficiaries to ensure compliance with CMS regulations. Ensuring that CMS timelines are met for all LEP processes as well as leading the reconsideration process for UCare. .
  • Manage the daily error reports of UCare’s eligibility file to PBM ensuring discrepancies are identified and resolved. In addition responsible for the submission of 4RX and TRR data to DHS as needed.
  • Partner with Enrollment, Information Systems, Data Reporting and Sales to resolve reconciliation and payment issues and problems. Directly support the Member Service Department in researching, resolving and responding to complex recon/enrollment issues
  • Maintain a thorough knowledge of the AMISYS membership application, InfoCrossing, MARx, MRRS and use of Excel spreadsheets. Maintain an understanding of the core operating computer system and a comprehensive knowledge of the Enrollment and Billing and Accounts Receivable Subsystem as it relates to the Membership Accounting Procedures.
  • Understand related AMISYS activity including Claims, Clinical Services, Provider Network Management and Premium Billing to provide accurate reconciliation activity.
  • Assist with the compiling of data for compliance reviews, site visits or surveys.
  • Assist in the training of reconciliation related activities and provide input on reconciliation policies and procedures.
  • Other projects and duties as assigned.

Two year degree in business or finance, relevant experience with enrollment billing and reconciliation in a managed care/HMO environment will be considered in lieu of degree. Minimum 2-3 years experience in health care or medical insurance is required. Reconciliation experience is required.  Experience with data entry, word processing and spreadsheets are needed. Experience with reconciliations of enrollment/billing information in a HMO or insurance related environment is preferred. Experience with Medicare and Special Needs Plans is desired.

The knowledge, skills, and abilities required to be successful in this role include: 

  • Demonstrated problem-solving skills.
  • Demonstrated organizational and time management skills, with a keen ability to prioritize.
  • Basic accounting skills.
  • Excellent oral, written and interpersonal communication skills.
  • Knowledge of Microsoft Office products i.e. Word, Excel, and Access.
  • Ability to present information and conduct training.
  • Ability to adapt to change.
  • Strong conflict resolution skills.
  • Ability to maintain confidentiality in all circumstances.

At UCare, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve. EOE/AA



Enter a highly collaborative environment where people are truly engaged, and feedback is valued. You???ll enjoy a competitive salary and benefits, as well as a host of other perks, including a nationally recognized wellness program, and a bright, open, award-winning office space in Northeast Minneapolis???just minutes from major freeways and retail centers. At UCare, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.

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