HealthCare Support · 10 hours ago
Manager of Enrollment & Reconciliation
Huntington Beach, CA
Full-time
Hybrid
Mid, Senior Level
$90K/yr - $110K/yr
6+ years expHealthCare Support is seeking a Manager of Enrollment & Reconciliation to support a Medicare Advantage Plan, delivering accessible, culturally attuned healthcare to the diverse populations it serves in Huntington Beach, CA. The role involves overseeing and optimizing all Medicare Advantage enrollment and reconciliation processes to ensure accuracy, compliance, and operational efficiency.
DatabaseHealth Care
Hiring Manager
Melanie Williams
Responsibilities
Oversee and optimize all Medicare Advantage enrollment and reconciliation processes to ensure accuracy, compliance, and operational efficiency
Serves as the organization’s expert on CMS rules, MARx transactions, eligibility policies, retroactive adjustments, and payment reconciliation requirements
Leads the team by setting priorities, guiding goals, and ensuring high-quality data capture and reporting
Manages MARx transaction processing, resolves rejections, reconciles CMS response files, and ensures alignment between internal systems and downstream partners like PBMs, claims, and finance
Identifies discrepancies, maintains governance around enrollment and payment accuracy, and ensures timely corrective actions
Qualification
Required
Bachelor's degree or equivalent combination of education and experience
2 years of enrollment and reconciliation supervisory experience
4 years of Medicare Enrollment experience at the health plan level
Experience Medicare Advantage Enrollment and Reconciliation rules and regulations, including CMS enrollment policy, MARx processing, payment reconciliation, and audit requirements
Expert-level knowledge of Medicare Advantage audit, compliance, enrollment, reconciliation, and regulatory reporting requirements
Expert knowledge of Medicare Advantage enrollment transactions, reconciliation processes, and CMS enrollment policy
Advanced understanding of MARx transaction codes, CMS response files, and enrollment reconciliation workflows
Ability to interpret and apply CMS guidance, HPMS memos, and the Plan Communications User Guide (PCUG) to operational scenarios
Company
HealthCare Support
HealthCare Support is a national niche recruitment firm that has a singular focus - placing top talent in the dynamic healthcare industry.
51-200 employees
Funding
Current Stage
Growth StageTotal Funding
unknown2021-11-29Acquired
2016-10-01Non Equity Assistance
Leadership Team
Clay Coleman
Chief Operating Officer
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