Huron helps its clients drive growth, enhance performance and sustain leadership in the markets they serve. We help healthcare organizations build innovation capabilities and accelerate key growth initiatives, enabling organizations to own the future, instead of being disrupted by it. Together, we empower clients to create sustainable growth, optimize internal processes and deliver better consumer outcomes.
Health systems, hospitals and medical clinics are under immense pressure to improve clinical outcomes and reduce the cost of providing patient care. Investing in new partnerships, clinical services and technology is not enough to create meaningful and substantive change. To succeed long-term, healthcare organizations must empower leaders, clinicians, employees, affiliates and communities to build cultures that foster innovation to achieve the best outcomes for patients.
Joining the Huron team means you’ll help our clients evolve and adapt to the rapidly changing healthcare environment and optimize existing business operations, improve clinical outcomes, create a more consumer-centric healthcare experience, and drive physician, patient and employee engagement across the enterprise.
Join our team as the expert you are now and create your future.
Huron is a global consultancy that partners with healthcare organizations to drive operational transformation, financial performance, and regulatory compliance.
We are seeking a Subject Matter Expert with Cognizant’s Financial Reconciliation Manager (FRM) product with deep expertise in health plan operations, premium billing, and Facets configuration/integration. This role will support payer clients in reconciling premium billing and payments from government programs (Medicaid, Medicare) and financial data across multiple systems, ensuring accuracy, compliance, and financial integrity across all government lines of business.
This is a highly visible role focused on identifying revenue leakage, ensuring accurate financial reporting, and optimizing reconciliation processes across the healthcare payer ecosystem.
Key Responsibilities
- Lead end-to-end financial reconciliation processes across premium billing, and payment workstreams
- Reconcile data across Facets (including 834s) and FRM, and downstream financial systems to ensure consistency and accuracy
- Perform variance analysis to uncover financial leakage, misapplied payments, or configuration-driven errors
- Analyze and support Facets and FRM configuration to ensure financial outcomes align with contract intent
- Partner with configuration and IT teams to troubleshoot financial discrepancies tied to system setup or rule logic
- Ensure alignment between financial reporting outputs
- Ensure reconciliation processes support CMS, Medicare Advantage, and Medicaid financial and reporting requirements
- Support financial validation for risk adjustment and regulatory reporting
- Prepare and review financial data used for audits, compliance checks, and external reporting
- Validate cross-system data to ensure accurate financial reporting and reduce revenue leakage risks
- Develop and implement solutions to improve data quality, reconciliation accuracy, and financial transparency
- Partner with Finance, Actuarial, Enrollment, EDI, and IT teams to resolve reconciliation and reporting issues
- Translate business and financial requirements into clear reconciliation frameworks and system requirements
- Provide strategic guidance to clients on best practices for financial operations and reconciliation processes
- Design and implement automated reconciliation processes and reporting tools
- Support system testing (UAT, regression, validation) to ensure financial accuracy
- Document reconciliation methodologies, controls, and operational procedures
Required Qualifications
- 5+ years working experience within Healthcare Payer Operations
- 5+ years of healthcare payer experience (Medicare and Medicaid)
- 5+ years of experience in financial reconciliation, billing analysis, or payer financial operations
- 5+ years of hands-on experience with Facets (TriZetto), particularly with FRM
- Strong expertise in:
- Financial workflows
- 834 transactions and EDI data structures
- Reconciliation processes across premium billing
- Proven ability to:
- Identify and resolve complex financial discrepancies
- Analyze large datasets and perform root cause analysis
- Experience working in a consulting or client-facing environment
- Experience with collaboration & team communication
Preferred Qualifications
- Experience with:
- Premium billing
- Risk adjustment and encounter financial validation
- Audit functions
- Identification and tracking of payment discrepancies for Medicare Part C and Part D reimbursements using TriZetto Financial Reconciliation Manager.
- Streamlining workflow and improving efficiency in reconciliation processes.
- Generate and analyze financial reports to support payment resolution and financial management.
- Collaborate with team members to resolve discrepancies and maintain accurate membership data.
- Strong SQL or data analytics experience
- Experience with large-scale payer system implementations
- Experience working with AI tools such as CoPiot, ChatGPT, Claude
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Position Level
Consultant
Country
United States of America
