Enrollment Analyst

Neighborhood Health Plan of Rhode Island•Smithfield, RI

About The Position

The Enrollment Analyst is responsible for eligibility and enrollment functions related to membership enrollment and disenrollment, including processing Electronic Data Interchange (EDI) files, analyzing error reports and trends, and identifying solutions that support data accuracy and integrity. The role presents an integrated view of enrollment to management and external partners while supporting the organization's mission, vision, and values. The position processes membership enrollment data, researches eligibility through contract reviews and benefit criteria, reviews EDI files and discrepancies, and develops enrollment activity and Cognos reports. It also provides eligibility oversight for delegated entities, communicates with external agencies and partners to resolve enrollment issues, and handles benefit coordination, outreach, reporting, and member disenrollment. Additional duties include quality audits, reporting births and coordination of benefits information, training staff, and performing other assigned duties.

Requirements

High school diploma or GED.
A minimum of 3–5 years of Health Plan/HMO experience.
Strong organizational, problem-solving, and analytical skills.
Strong verbal and written communication skills for interaction with internal and external clients.
Ability to work independently and as a team player while handling multiple responsibilities and meeting timelines.
Experience analyzing data and developing reports.
Proficiency in Microsoft Office Suite.

Nice To Haves

Previous experience in an enrollment position is strongly preferred.
One year of experience with EDI processes and 834 benefit enrollment is strongly preferred.
Associate degree in Business or a health-related area.
Experience working with EDI and/or 834 files.

Responsibilities

Process membership enrollment data accurately, including researching eligibility through contract reviews and benefit criteria requirements.
Analyze EDI files by converting them using EDI Power Reader or Map Force into Excel and running macros to identify member updates and support eligibility reconciliation.
Review EDI files, identify discrepancies, and research processing solutions.
Generate Cognos reports and recommend additional reporting updates to the Business Analytics team to improve department efficiency.
Generate enrollment activity reports for internal and external customers.
Analyze error reports and trends from 834 files against delegated entity membership.
Provide FDR eligibility oversight of delegated entities through EDI review and conversion of 834 files into a readable format.
Communicate daily with EOHHS, DCYF, Health Source RI, and HP to resolve enrollment issues.
Handle benefit coordination, outreach, reporting, and member disenrollment functions while identifying process improvements and workflow efficiencies.
Perform quality audits of enrollment changes to maintain data integrity, including reporting births to EOHHA and coordination of benefits.
Train new staff members and non-enrollment staff as required.
Perform other duties as assigned.