Senior Reconciliation & Recovery Analyst

Requirements

• Bachelor's degree from an accredited institution
• Working experience exhibiting strong critical thinking and analytical skills
• Familiarity with writing SQL queries for the purpose of analyzing data and establishing business rules and requirements
• Familiarity with relational database structures, theories, principles, and practices
• Familiarity with data models and/or data modelling
• Ability to understand the data lifecycle within the organization and its impact on the business
• Experience working in a team-oriented, collaborative environment
• Ability to communicate effectively verbally and in writing while demonstrating good grammar, spelling, and punctuation skills
• Ability to work effectively with both business and technical stakeholders
• Work experience requiring meticulous attention to detail
• Degree in Mathematics, Computer Science, Data Sciences, Engineering, Business Analytics, Informatics, or similar concentration
• Experience with Alteryx, Tableau, Amazon Redshift, or other similar tools/platforms
• Familiarity with statistical principles, such as standard deviations, normal distributions, and regressions
• Familiarity with healthcare data, especially enrollment data

Benefits

Additional Information

The Enrollment & Billing (E&B) Senior Reconciliation & Recovery Analyst ensures member data is accurate so eligible Healthfirst members' premium collection from the State is completed in a timely manner. The incumbent also supports various activities within E&B aimed at minimizing future audit findings by identifying and resolving inconsistencies between Healthfirst, NY State of Health (NYSoH) and Department of Health (DOH). Duties & Responsibilities: Operate with intellectual curiosity and critically assess existing processes and procedures to identify opportunities for improvement Develop complex analyses requiring the integration of multiple data sources, evaluation of data quality, and standardization of data to consistent format/structure Create advanced queries and reports that extract data to support business teams' needs, including working with nesting tables and temp tables and writing multiple conditions against varying data sets Summarize and present data outcomes, recommendations, and methodology to Reconciliation and Recovery leadership, E&B leadership, and enterprise stakeholders Create and run routine reporting to monitor the enrollment activities of a defined population and ensure data accuracy Analyze large data sets and identify patterns within the defined population to organize the backlog, determine outliers and identify root-causes of membership, payment or other data discrepancies Determine short and long-term actions to resolve current cases of membership/ payment discrepancies and new ones from reoccurring Understand, validate and document the business rule(s) to flag membership for reconciliation and/ or premium recovery for a defined population Liaison between department leaders, subject matter experts, Healthfirst finance, etc. Develop strategy and potential solutions to resolve membership discrepancies within the defined population Establish job-aids to enable user-correction of membership errors and/or submission of information to the DOH and NYSoH Work with outsourced vendors to enable them to resolve cases flagged for manual correction Partner with the Quality Assurance (QA) team to develop a QA model to ensure quality, compliance and regulatory standards are met Work collaboratively across the department and organization to share best-practices and coordinate corrective actions applicable to other populations Establish tracking mechanism to track effectiveness and data accuracy within the defined population and report results to senior leadership Other duties as assigned or requested

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