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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in QNXT enrollment and billing processes, with a strong ability to analyze and reconcile complex financial and membership data while ensuring compliance with CMS and HIPAA regulations. Proficient in developing operational reports and dashboards to support decision-making and process improvements.
Highest-signal resume keywords
QNXT Enrollment And Billing ExpertiseSQL-Based Queries And Automated ReportingCMS Enrollment Reconciliation KnowledgeFinancial Reconciliation And Internal ControlsOpen Enrollment And Special Enrollment Period Management
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Data AnalysisBilling ReconciliationFinancial Transactions MonitoringOperational ReportingPayment ProcessingEnrollment Issue ResolutionMetrics DevelopmentSOP DocumentationProcess MappingEscalated Inquiry Handling
Soft Skills
Problem SolvingCollaborationMentoringCommunicationAttention To Detail
Tools & Technologies
QNXTCMSEDGE ServerMLR ReportingFinancial Reporting Tools
Industry Keywords
CMS CompliancePHI SafeguardingHealth Plan RequirementsFederal And State RegulationsEnrollment Data Dispute Submission
Tech Stack
Tools & technologiesSQL
About the role
Key responsibilities & impact- Analyze enrollment and eligibility transactions, files, reports, and data exchanges to identify discrepancies, errors, trends, and operational risks
- Validate member records and resolve complex enrollment issues
- Review, validate, and generate member and group invoices
- Resolve billing disputes, premium discrepancies, and payment-related issues
- Perform premium, payment, membership, and account reconciliations
- Monitor invoices, payments, adjustments, refunds, financial transactions, and billing outputs
- Analyze large enrollment, billing, payment, membership, and financial datasets
- Develop operational reports, dashboards, reconciliations, metrics, and insights for leadership and operational partners
- Partner with business and technology teams on queries, reporting, validation, reconciliation, and workflow solutions
- Support market implementations, product launches, system conversions, testing, production readiness, and scalable process design
- Ensure compliance with CMS, federal, state, health plan, and organizational requirements
- Support internal and external audits
- Execute monthly CMS enrollment reconciliation for Federally Facilitated Marketplace states and equivalent state-based exchange reconciliation
- Reconcile 820 payment transactions and CMS policy-based payment reports to QNXT membership
- Administer binder payment, grace period, delinquency, and non-payment termination processes
- Ensure accurate downstream enrollment and premium data flows, including EDGE, MLR, capitation, and vendor eligibility files
- Support Finance month-end close and document internal controls
- Resolve escalated member, broker, CMS CTM, and state Department of Insurance inquiries
- Lead Open Enrollment, renewal, passive re-enrollment, and Special Enrollment Period readiness
- Monitor delegated enrollment, billing, and payment vendors
- Serve as QNXT enrollment and billing subject matter expert and mentor analysts
- Safeguard member PHI and financial data
Requirements
What you’ll need- Experience/knowledge sufficient to serve as a QNXT enrollment and billing subject matter expert
- Ability to analyze enrollment, eligibility, billing, payment, membership, and financial data
- Experience with QNXT membership and billing processes
- Experience with SQL-based queries and automated reporting
- Knowledge of CMS, federal, state, health plan, and organizational requirements
- Knowledge of CMS enrollment reconciliation, including RCNI/RCNO processing and enrollment data dispute submission
- Knowledge of 820 payment transactions and CMS policy-based payment reports
- Knowledge of binder payment, grace period, delinquency, and non-payment termination processes
- Knowledge of APTC, member premiums, user fees, EDGE server submissions, MLR premium reporting, capitation membership, and vendor eligibility files
- Experience supporting financial close, reconciliations, and internal controls
- Experience handling escalated member, broker, CMS CTM, and state Department of Insurance inquiries
- Experience with Open Enrollment, renewals, passive re-enrollment, and Special Enrollment Periods
- Experience monitoring delegated vendors against service levels and accuracy standards
- Ability to safeguard PHI and financial data in compliance with HIPAA and privacy/security policies
- Ability to develop reports, dashboards, reconciliations, performance metrics, SOPs, process maps, training materials, and implementation documentation
Benefits
Comp & perks- Multiple health and dental plans with nationally recognized networks
- Vision benefits
- Total wellness program
- Employee assistance program for employee and family
- Competitive wages
- Retirement savings plans
- Company-paid disability and life insurance
- Pre-tax savings opportunities (HSA and/or FSA)
- Professional development offerings
- Opportunities for remote work
- Generous paid-time-off program
- Flexible scheduling to accommodate unexpected events