Enrollment Analyst

Neighborhood Health Plan Of Rhode Island-posted about 1 year ago
Full-time
Remote • Smithfield, RI
Insurance Carriers and Related Activities
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The Enrollment Analyst is responsible for managing all eligibility and enrollment functions related to membership enrollment and disenrollment. This includes processing Electronic Data Interchange (EDI) files, analyzing error reports, and identifying solutions to ensure data accuracy and integrity. The role involves collaboration with management and external partners to support the organization's mission and values.

  • Processes enrollment data for membership with accuracy, including researching membership eligibility through contract review and benefit criteria requirements.
  • Analyzes data on Electronic Data Interchange (EDI) files by converting files through EDI power reader or Map Force into Excel, and running macros to identify which members require updates and ensure eligibility reconciliation.
  • Completes EDI reviews, identifies discrepancies, and researches processing solutions.
  • Generates Cognos reports and recommends updates for additional Cognos reporting through the Business Analytics team to increase department efficiencies.
  • Generates enrollment activity reports for both internal and external customers.
  • Analyzes error reports and trends from 834 files against delegated entity membership.
  • Provides FDR Eligibility oversight of delegated entities for EDI review through conversion of 834 files into readable format.
  • Communicates with Executive Office of Health & Human Services (EOHHS), Department of Children, Youth & Family Services (DCYF), Health Source RI (HSR), and HP on a daily basis to resolve enrollment issues.
  • Handles all functions related to Benefit Coordination, Outreach, Reporting, and member disenrollment while identifying process improvement and workflow efficiencies.
  • Performs quality audits for enrollment changes to maintain data integrity, including reporting births to EOHHA and COB.
  • Trains new staff members and non-enrollment staff as required.
  • Performs other duties as assigned.
  • High School diploma or GED required.
  • Minimum of 3-5 years Health Plan/HMO experience.
  • Previous position in Enrollment strongly preferred.
  • 1 year experience with EDI process and 834 benefit enrollment strongly preferred.
  • Excellent organizational, problem-solving, and analytical skills.
  • Strong verbal and written communication skills for interaction with internal and external clients.
  • Experience working independently and as a team player while handling multiple responsibilities and meeting timelines.
  • Previous experience analyzing data and developing reports.
  • Proficiency in Microsoft Office Suite.
  • Associates degree in Business or Health related area.
  • Experience working with EDI and/or 834 files.
  • Health insurance
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