Cambridge MA 02141 58 Charles Street

Job Description

This positions monitors and corrects all membership data discrepancies between the plan and CMS, Medicare, and Medicaid. Works closely with CMS, Medicaid and intermediaries, to resolve discrepancies.
  • Responsible for detailed and precise investigation, resolution and appropriate adjusting entry of complex member demographic data into company's database from daily Medicaid and Medicare files, customer service, provider relations request and other change request sources.
  • Coordinates all activities related to resolving CMS and Medicaid data and payment discrepancies including enrollment and disenrollment processes.
  • Monitors and supports data and processes required to accurately review expected revenue and the correlation with actual payment from CMS and Medicaid.
  • Ensures the correct processing of CMS and Medicaid transactions including current and retroactive enrollment and disenrollment.
  • Reconciles monthly and quarterly 820 and 834 reports.
  • Resolves enrollment and membership data variances between CMS, Medicaid and company data submitted by the Enrollment Department to CMS and Medicaid.
  • Coordinates reconciliation of enrollment transactions, creates and processes all retroactive transaction correction files.
  • Reconciles electronic membership files received from CMS and Medicaid within the appropriate frequency and timeliness to ensure eligibility is accurate and current.
  • Supports and manages analysis of transaction reply reports (TRR) and Medicaid 834 transaction processing, and follows up reconciliation processes related to resolution of issues identified.
  • Coordinates efforts between Enrollment and Finance departments and supports management discussions regarding membership reconciliation.
  • Works with supervisor to establish new workflow processes and/or change existing processes as business requires.
  • Assists in the review and development of departmental policies and procedures.

General Job Information





Job Family

Operations Group


United States of America

FLSA Status

United States of America (Non-Exempt)

Recruiting Start Date


Date Requisition Created


Work Experience

Managed Healthcare, Medicaid, Medicare


A Combination of Education and Work Experience May Be Considered. (Required), Bachelors (Required)

License and Certifications - Required

License and Certifications - Preferred

Other Job Requirements


  • 2+ years of experience in a Medicare/Medicaid managed care environment.
  • Working knowledge of Medicare and Medicaid enrollment and reconciliation requirements, CMS reporting, and data analysis.
  • Solid understanding of the Medicare and Medicaid payment methodology.
  • Strong verbal and written communication skills.
  • Organized with strong attention to detail.
  • Ability to meet deadlines.
  • Strong working knowledge of Microsoft Office Product Suite.

Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.