Reconciliation Specialist - Medicare and Exchange

Minneapolis, Minnesota
Nov 22, 2017
Jan 03, 2018
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.



At UCare, we deliver high-quality health coverage and services to help members of all ages maintain and improve their health. It's a big job that takes innovative ideas, strategic partnerships, and a commitment to doing the right thing. Above all, it takes a compassionate team that is dedicated to making a real difference in the lives of our members and our communities.


Working at UCare is more than just a career; it's a mission. A mission that defines us as professionals, unites us as an organization, and shapes how we interact with our members and each other. Our values of integrity, community, quality, flexibility, and respect permeate every aspect of our organization - from who we are and how we act, to what we do and how we do it. We owe our continued success to our employees who proudly embody our mission and values in everything they do.


Position Description

This position is responsible to reconcile UCare's CMS/MNsure enrollment/revenues for the Exchange product, Advance Premium Tax Credit (APTC), Cost Sharing Reduction (CSR) and to reconcile members Electronic Funds Transfer (EFT) payments.  Compare information in UCare's operating systems to information provided from paying entities.  Reconcile Exchange membership enrolling via a Broker; reconcile AOR forms received, update Exchange member EFT information and reconcile and submit for payment.  Research, track and respond to telephonic inquiries in regards to our Medicare members being assessed Late Enrollment Penalty (LEP).  Respond to Broker email inquiries for both our Medicare and Exchange membership and maintain an understanding of the quarterly commission process.  Identify and report reconciliations performed and work with the Enrollment department to resolve differences. 

·Reconcile MNsure/CMS member premium, APTC and CSR:  a) Match premium amounts billed with MNsure expected b) Match APTC and CSR collected from CMS with expected payments and verify enrollment with UCare's eligibility system at the member level c) Work with Enrollment to resolve discrepancies d) Identify journal entry dollar amounts for related transaction activity.

·Research, track and request letters for Medicare members being assessed LEP and respond to telephonic inquiries and written requests from our members or the CMS reconsideration vendor regarding a beneficiary attestation or appeal of LEP.  Make follow-up telephonic inquires as needed

·Analyze the monthly aging reports for Exchange members; determining appropriate correspondence is mailed each month with accurate dates and grace periods; creating status updates as needed.  Validate, track each delinquency period based on APTC or Non-APTC.  Validate correct proposed termination notice is mailed to the correct members and the system is updated with the correct termination date on the correct date of each month.

·Reconcile and update the Exchange EFT file before requesting premiums to ensure accuracy of the premium payments of our Exchange members

·Research Members On Review (MOR) and MNsure Hold members to ensure accuracy.  Work with Enrollment to resolve discrepancies.  Create monthly suppress file for members that should not be voided for not effectuating their plan.

·Research members with QHP (Qualified Health Plan) changes; researching, validating accurate letters are mailed to members, validing system updates occur as required, validating members status is updated as required.

·Support Customer Service and Enrollment in researching Exchange members to determine qualification for reinstatement of coverage

·Create and maintain clear step by step processes for each function.

·Support cash application clean up across all lines of business

·Support Medicare/Exchange Member Service in researching, resolving and responding to complex reconciliation issues and dual eligible issues.

·Complete outreach calls to members regarding complex questions/concerns

·Maintain an understanding of:  Enrollment and Billing Subsystem as it relates to the Billing and Enrollment Procedures, Exchange, Medicare, Special Needs Plans, State Public Programs and MNsure and CMS (APTC and CSR) as pertains to our Exchange product; and CMS computer systems (MARx).

·Other projects and duties as assigned. 


Bachelor's degree; demonstrated experience may be considered in lieu of degree.

Required Experience

Experience with reconciliation of enrollment and premium billing information in an insurance related environment.  Experience with Medicare and Commercial.

Preferred Experience

Healthcare; ITIL and/or IT industry standard frameworks; SharePoint.


UCare is proud to be a recognized Star Tribune Top Workplace for the 8th consecutive year. As a part of our collaborative team, you'll experience the rewards that come with helping others and seeing the positive results of your hard work. We value and respect each individual's ideas and contributions, and give you the freedom to grow both personally and professionally. We are centrally located, and offer onsite education, equipment and wellness resources, a myriad of volunteer activities, and a number of other rewards. If you're looking for a welcoming environment that celebrates what you have to offer, helps you build on your strengths, and gives you the opportunity to truly make a difference, we invite you to apply.

As an Equal Opportunity/Affirmative Action Employer, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.





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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