MediGold is a not-for-profit Medicare Advantage insurance plan serving seniors and other Medicare beneficiaries across the United States. Were dedicated to providing excellent customer service cost-effective care and exceptional healthcare coverage. We rely on talented colleagues in a wide variety of professional roles including information technology financial analysis audit provider relations and more.

Position Purpose

Reconciliation Analyst plans organizes conducts and monitors the enrollment and reconciliation process to ensure accurate membership processing application and reconciliation of all data and payments from CMS as well as accurate billing and premium payment reconciliation of the plans membership
Organizes conducts and monitors the special status tracking process to ensure accurate reporting and payment from CMS for enrollees who fall into a special payment status category.
Responsible for all eligibility and membership functions relating to enrollment disenrollment special status billing premiums revenue and reconciliation processes for the health plan in accordance with Federal regulatory requirements and the Centers for Medicare and Medicaid Services (CMS). Responsible for ensuring the eligibility demographic data billing and revenue for
membership is accurate. Organizes conducts and monitors the enrollment and billing processes to ensure accurate and timely transactions and revenue from CMS and members

What You Will Do:

• Assures provision of timely and accurate enrollment information (letters certificates Member Agreement handbooks ID cards etc.) to members in accordance with department standards policies and procedures.

• Reconciles the CMS transaction reply reports against the membership files of the health plan in accordance with department standards policies and procedures to ensure accuracy and meet Federal requirements.

• Maintains current knowledge of CMS regulations related to enrollment disenrollment billing and special statuses.

• Compile information and documentation to support special status payment requests to governmental agencies.

• Respond to written and verbal requests for information from federal and local Government agencies such as CMS or state department of insurance.

• Monitors and effectuates membership and financial transactions including payment posting reconciliation electronic funds transfer posting and maintenance late letter process processing of returned payments billing statements evaluation and completion of required reporting.

• Willingness to learn and comprehend various aspects of Plan and identify engagement opportunities and integration points.
  

Minimum Qualifications

• Education: Associates degree in business or related field preferred or equivalent experience required.

• Experience: Managed care insurance industry experience required.

• Able to apply regulations to work processes.

• Proven ability to successfully work with internal and external groups to accomplish reconciliation of payment reports and activities.

• Proven skill and ability to track and report financial and statistical data.

• Knowledge of computer systems including Microsoft Office.

• Service-oriented individual with an ability to effectively resolve customer issues.

• Analytical and problem solving skills.

Position Highlights and Benefits:

• Mount Carmel Health System recognized by Forbes in 2025 as one of Americas Best State Employers.
• Competitive compensation and benefits packages including medical dental and vision with coverage starting on day one.
• Retirement savings account with employer match starting on day one.
• Generous paid time off programs.
• Employee recognition programs.
• Tuition/professional development reimbursement starting on day one.
• RN to BSN tuition 100% paid at Mount Carmels College of Nursing.
• Relocation assistance (geographic and position restrictions apply).
• Employee Referral Rewards program.
• Mount Carmel offers DailyPay - if youre hired as an eligible colleague youll be able to see how much youve made every day and transfer your money any time before deserve to get paid every day!
• Opportunity to join Diversity Equity and Inclusion Colleague Resource Groups.

Ministry/Facility Information:

Mount Carmel a member of Trinity Health has been a transforming healing presence in Central Ohio for over 135 years. Mount Carmel serves over 1.3 million patients each year at our five hospitals free-standing emergency centers outpatient facilities surgery centers urgent care centers primary care and specialty care physician offices community outreach sites and homes across the region. Mount Carmel College of Nursing offers one of Ohios largest undergraduate graduate and doctor of nursing programs. If youre seeking a rewarding career where your purpose passion and desire to make a difference come alive we invite you to consider joining our team. Here care is provided by all of us For All of You!

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race color sex age national origin religion sexual orientation gender identity status as a veteran and basis of disability or any other federal state or local protected class.