Financial Reconciliation Manager

📋 Description

• Oversee comprehensive financial reconciliation processes across premium billing and payment workflows.

• Ensure data consistency and accuracy by reconciling information from Facets (including 834s), FRM, and downstream financial systems.

• Conduct variance analysis to identify financial leakage, misapplied payments, or errors stemming from configurations.

• Evaluate and support Facets and FRM configurations to guarantee that financial results align with contractual intentions.

• Collaborate with configuration and IT teams to investigate financial discrepancies related to system setup or rule logic.

• Maintain consistency between financial reporting outputs.

• Ensure that reconciliation processes comply with CMS, Medicare Advantage, and Medicaid financial and reporting standards.

• Assist in financial validation for risk adjustment and regulatory reporting purposes.

• Prepare and review financial documentation utilized for audits, compliance assessments, and external reporting.

• Verify cross-system data to ensure precise financial reporting and mitigate revenue leakage risks.

• Create and implement strategies to enhance data quality, reconciliation precision, and financial transparency.

• Collaborate with Finance, Actuarial, Enrollment, EDI, and IT teams to address reconciliation and reporting challenges.

• Convert business and financial requirements into coherent reconciliation frameworks and system specifications.

• Offer strategic advice to clients on optimal practices for financial operations and reconciliation processes.

• Design and establish automated reconciliation processes and reporting tools.

• Assist in system testing (UAT, regression, validation) to ensure financial accuracy.

• Document reconciliation methodologies, controls, and operational procedures.

⛳️ Requirements

• Minimum of 5 years of experience in Healthcare Payer Operations.

• At least 5 years of experience within the healthcare payer sector (Medicare and Medicaid).

• Over 5 years of experience in financial reconciliation, billing analysis, or payer financial operations.

• A minimum of 5 years of hands-on experience with Facets (TriZetto), especially with FRM.

• Strong proficiency in financial workflows, 834 transactions, EDI data structures, and reconciliation processes related to premium billing.

• Demonstrated capability to identify and rectify complex financial discrepancies and analyze large datasets for root cause analysis.

• Experience in a consulting or client-facing role.

• Proven ability to collaborate and communicate effectively within teams.

🏝️ Benefits

• Medical, dental, and vision coverage for employees and their dependents.

• A 401(k) plan featuring a generous employer match.

• An employee stock purchase program.

• A generous Paid Time Off policy.

• Paid parental leave and adoption assistance.

• Complimentary annual health screenings and coaching.

• Bank at work program.

• On-site workshops.