Revenue Reconciliation Analyst

Reconciles memberships and premiums between the Health Plan and government partners. Conducts timely reporting, offers process improvement recommendations, and works collaboratively on the reconciliation processes for WellCare’s membership to ensure we receive the appropriate premium. Works closely with service partners within the Corporate/Regional sites and develops business contacts as deemed appropriate.

Reports to: Manager, Revenue Reconciliation

Department: Finance

Location: Tampa, FL

Essential Functions:

  • Multi-tasks using multiple internal and external applications to identify and research monthly premium discrepancies between expected premium and actual payments.
  • Downloads reconciliation results into management reporting tools and performs the tracking, research and resolution of identified discrepancies.
  • Engages in membership eligibility research, requiring critical thinking skills and the ability to analyze and resolve payment discrepancies, to maximize the collection of accurate revenue.
  • Provides management with monthly established Financial Indicators.
  • Quantifies and documents revenue implications of payment discrepancies.
  • Contributes to the development and documentation of reconciliation workflows and educational tools used to facilitate cross training and internal controls.
Additional Responsibilities:
    Candidate Education:
    • Required A High School or GED
    • Preferred Other Some college curriculum a plus
    Candidate Experience:
    • Required 2 years of experience in Any combination of Reconciliation, Auditing, Accounting, or Member Enrollment experience
    • Preferred Other Health insurance experience; prior experience with government program regulations, 1 years government payer system experience, and/or Xcyels experience is a plus
    Candidate Skills:
    • Intermediate Demonstrated analytical skills
    • Intermediate Demonstrated problem solving skills
    • Intermediate Other Detail oriented
    Licenses and Certifications:
    A license in one of the following is required:
      Technical Skills:
      • Required Intermediate Microsoft Excel
      • Required Intermediate Microsoft Word
      • Required Intermediate Microsoft Access
      • Required Intermediate Microsoft PowerPoint
      • Preferred Intermediate Other Paradigm and Sidewinder

        About us
        Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses exclusively on providing government-sponsored managed care services through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans to families, children, seniors and individuals with complex medical needs. WellCare is a Fortune 500 company, and in 2018, was recognized as a Fortune "World's Most Admired Company", ranking in the top five among the health insurance and managed care industry-a testament to the hard work and dedication of the company's nearly 9,000 associates who each day live WellCare's values and deliver on its mission to help its members live better, healthier lives. The company serves approximately 4.4 million members nationwide as of Dec. 31, 2017. For more information about WellCare, please visit the company's website at EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, creed, age, sex, pregnancy, veteran status, marital status, sexual orientation, gender identity or expression, national origin, ancestry, disability, genetic information, childbirth or related medical condition or other legally protected basis protected by applicable federal or state law except where a bona fide occupational qualification applies. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.