Accenture is a leading global professional services company that helps the world’s leading businesses, governments and other organizations build their digital core, optimize their operations, accelerate revenue growth and enhance citizen services—creating tangible value at speed and scale. We are a talent- and innovation-led company with approximately 743,000 people serving clients in more than 120 countries. Technology is at the core of change today, and we are one of the world’s leaders in helping drive that change, with strong ecosystem relationships. We combine our strength in technology and leadership in cloud, data and AI with unmatched industry experience, functional expertise and global delivery capability. We are uniquely able to deliver tangible outcomes because of our broad range of services, solutions and assets across Strategy & Consulting, Technology, Operations, Industry X and Song. These capabilities, together with our culture of shared success and commitment to creating 360° value, enable us to help our clients reinvent and build trusted, lasting relationships. We measure our success by the 360° value we create for our clients, each other, our shareholders, partners and communities. Visit us at www.accenture.com. Job Description:The Medicare Enrollment Sr Analyst is responsible for Medicare enrollment processing, membership reconciliation, and ongoing member maintenance. This role ensures the timely submission of enrollment files to Centers for Medicare & Medicaid Services (CMS) and the accurate processing of daily and monthly CMS eligibility files.Key Responsibilities:
Accurately and promptly reconcile CMS monthly enrollment files by resolving member demographic and status discrepancies through the Revenue Reconciliation Process.
Submit discrepancies for correction to the CMS Retroactive Processing Contractor (RPC) when applicable.
Ensure compliance with CMS regulations by processing CMS DTRR transactions and sending required member correspondence within established timelines.
Develop a comprehensive understanding of the CMS MARx system and its application features.
Professionally interact with internal stakeholders by addressing questions and inquiries while representing the department effectively.
Document inconsistencies, issues, or concerns thoroughly for follow-up and resolution by internal support staff or software vendors.
Track the status of assigned tasks and resolve related problem issues to completion.
Assist in developing and maintaining desk-level procedures related to job functions, system usage, and application maintenance.
Complete Electronic Data Validation within CMS-required timeframes.
Work daily audits and reports within the department’s Service Level Agreements (SLAs).
Monitor and track assigned queues for timely resolution.
Perform additional duties as needed. "
Candidate should have a substantial enrollment processing and reconciliation understanding and knowledge of the MA MAPD methodologies.
Prior experience using Market Prominence is preferred.
Basic Qualifications:
Minimum of 3 years of experience processing Medicare enrollment transactions.
Preferred:
Bachelors Degree.
Expert in Microsoft Office Suite with knowledge of V-lookups and pivot tables.
Candidate should have a substantial enrollment processing and reconciliation understanding and knowledge of the MA MAPD methodologies.
Prior experience using Market Prominence is preferred.
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