Long Term Care Reconciliation Specialist in Cambridge, MA at Pride Health

Date Posted: 11/18/2019

Job Snapshot

  • Employee Type:
  • Location:
    Cambridge, MA
  • Experience:
    Not Specified
  • Date Posted:

Job Description

Pride Health is looking for a Long Term Care Reconciliation Specialist to join our team in Cambridge, MA! This positions monitors and corrects all membership data discrepancies between the plan and Medicaid. Works closely with Medicaid and intermediaries to resolve discrepancies.

Job Duties 

  • Coordinates all activities related to resolving MA Medicaid data and payment discrepancies, including for members in Long Term Care Facilities.
  • Responsible for detailed and precise investigation, resolution and appropriate adjusting entry of complex member demographic data into company's and state’s databases.
  • Monitors and supports data and processes required to accurately review expected revenue and the correlation with actual payment from Medicaid.
  • Acts as a liaison between the plan and Long Term Care Facilities to ensure submission of all required documentation. 
  • Reconciles electronic membership files received from Medicaid within the appropriate frequency and timeliness to ensure eligibility is accurate and current.
  • 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.
  • The candidate will be completing system research - go into Magellan system and compare with the states system and complete eligibility research.
  • They will need to fix discrepancies based on reports from the state.The candidate will be calling skilled nursing facilities and state LTC unit. 


  • Bachelor's Degree
  • 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