Eligibility Analyst I

MedImpact Healthcare Systems, Inc.•San Diego, CA

19h•$22 - $36•Onsite

About The Position

The Eligibility Analyst I serves as a liaison between Account Management and the Eligibility Department and processes daily client eligibility files. The role validates eligibility file loads for accuracy, data integrity, completeness, and compliance with processing requirements; analyzes and remediates record exceptions; and monitors file activity and errors to support timely, accurate ingestion. The analyst works with internal stakeholders to confirm requirements, resolve processing issues, and advance issue resolution. The role provides day-to-day operational production support to Account Management and serves as an eligibility subject matter expert for strategic partners. It also supports audits and SOX compliance, helps meet performance guarantees, maintains eligibility reference documentation, and collaborates with IT Data Exchange on system enhancements for error handling, record reprocessing, file monitoring, and alerts. The position has no supervisory responsibilities. This is a full-time, non-exempt position. The typical schedule is Monday through Friday, 8:00 a.m. to 5:00 p.m.; overtime may be required from time to time, including nights, weekends, or holidays as business needs require. The position is on-site at the San Diego Headquarters or another company location, with remote work possible with management approval based on business requirements. No travel is required, though attendance at local conferences and meetings may be requested.

Requirements

Bachelor of Science or Bachelor of Arts degree and at least 1 year of experience, or an equivalent combination of education and experience.
Intermediate to advanced knowledge of Microsoft Office Suite.
After training, required experience using business applications such as Pharmscreens, EPSROI, and COB File Manager.
Ability to solve practical problems involving concrete variables and limited standardization, and to interpret written, oral, diagrammatic, or schedule-based instructions.
Ability to perform basic arithmetic and calculate rates, ratios, and percentages; ability to interpret bar graphs and apply fractions, percentages, ratios, and proportions to practical situations.
Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals.
Ability to present information effectively in one-on-one and small-group settings to customers, clients, and coworkers.
Ability to meet the position's physical demands, including occasionally lifting or moving up to 25 pounds, and maintaining close vision, color vision, and depth perception needed for detailed work.
Ability to work overtime from time to time, including nights, weekends, or holidays when required by business needs.
Ability to provide adequate support to internal clients and participate in regular coordination and collaboration with employees, colleagues, clients, or vendors.

Nice To Haves

Data analysis experience is preferred.
Healthcare eligibility experience is a plus.

Responsibilities

Process daily client eligibility files.
Perform quality assurance validation of eligibility file loads to verify data integrity, completeness, and compliance with established processing requirements.
Analyze and manually remediate eligibility record exceptions and data discrepancies to support accurate downstream processing.
Coordinate with Account Management to validate file requirements, resolve processing issues, and ensure timely and accurate eligibility file ingestion.
Research and perform more complex cleanup related to eligibility and synchronization issues with appropriate parties.
Provide primary day-to-day operational production support to Account Management and serve as the centralized eligibility subject matter expert for strategic partners.
Drive technical system enhancements for error-log handling, failed member record reprocessing on behalf of clients, automated file monitoring, and alerts in collaboration with IT Data Exchange.
Write and maintain detailed eligibility reference documentation.
Oversee quality review of eligibility file loads and accountability for performance guarantees.
Assist with audits and SOX compliance.
Verify that TPA and Commercial Carrier batch file processing requests are completed; validate file delivery status or manually post files to secure FTP directories.