Job Posting for Insurance Membership Analyst at Complete Health
POSITION TITLE: VBC Membership Analyst
DEPARTMENT: Medical Economics
FLSA STATUS: Exempt
REPORTS TO: Director, Medical Economics
SUMMARY OF JOB DUTIES:
Responsible for analysis of patient membership and ensuring appropriate reconciliation to insurance plan assignment. Coordinates with multiple departments to identify payors for payor cost reallocations and makes corrections, as necessary.
ESSENTIAL JOB FUNCTIONS:
MSR monthly tracking report management - take ownership of, and reconcile this report to ensure agreement and status with Business Development and Medical Economics
Match MSR "enrolled" membership to payer rosters and to EMR to verify clinic visits
Determine status of a member on the roster and in EMR: able to run verification process
If the MSR enrollment list and payer rosters do not match, produce actionable lists to give to MSRs or other CH teams for outreach
Ensure those on VBC payer rosters are appearing in Athena with the right insurance and the right PCP
If payer roster and Athena do not match, or a clinic visit has not been scheduled/completed, produce actionable lists via Excel to give to MSRs or another CH team for outreach
Identify VBC eligible patients with CH clinic visits who are not on payer rosters or assigned to CH providers, and outreach to Payor/member to ensure selection and premium attribution for CH
Identify, document, and produce actionable assignments as necessary for monthly current and retroactive membership adds and deletions
Identify payer and "source / last PCP / reason" for each patient add
Ensure each patient who should be attributed to MSR are, and vice versa
Assess membership for "patient dumping" by other providers, payers
Clean up of member records for those who are inactive, have moved, changed PCPs, are deceased, or otherwise should not be attributed to CH under a VBC program, and ensure payers appropriately remove those patients from our rosters
Other "member" validation, reporting, and analytics, as necessary
Requirements:
MINIMUM REQUIREMENTS
Bachelor's degree in area of specialty required
Four to seven years of related experience
Familiar with and able to navigate EMRs to look up and verify patient information (Athena, Epic, etc.)
Sort data in excel to make it 'actionable' (proficient with Excel)
Willing to learn to use SQL to transfer data to Microsoft Excel
Strong organizational and analytical skills, attention to detail
Basic understanding of patient / insurance payer relationship and terminology
Salary.com Estimation for Insurance Membership Analyst in Jacksonville, FL
$147,538 to $194,681
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