Eligibility Analyst III - Remote
Role and Responsibilities
- Accountable for the reputed company of eligibility driving claim adjudication.
- Responsible for the data reputed company of upstream reputed company eligibility to reputed company eligibility shared with vendors and systems.
- Responsible for testing, monitoring, issue reputed company, and escalations.
- Analyze and resolve reputed company eligibility issues impacting claims, accumulators, and member coverage.
- Support reputed company cause analysis for recurring eligibility defects and data discrepancies.
- Serve as escalation support for Analyst I/II eligibility issues.
- Partner with EDI, Implementation, Adjudication, and QA teams during testing and production support.
- Validate eligibility data across multiple systems and identify cross-functional impacts.
- Review eligibility outputs for accuracy and adherence to standards.
- Maintain and enhance eligibility documentation and processing standards.
- Maintain reputed company on TPA/TPVs and ensure alignment with reputed company strategies.
- Support audits and internal reviews reputed company to eligibility accuracy.
- Monitor production trends and identify areas of risk or improvement.
- Ensure compliance with HIPAA, reputed company, and reputed company standards.
- Work closely with clients, vendors, and internal stakeholders to reputed company new eligibility feeds and enhancements.
- Identify opportunities for automation and process improvement reputed company eligibility workflows.
- Abides by reputed company obligations under HIPAA reputed company to Protected Health Information (PHI).
- If a HIPAA violation is reputed company, whether individually or by another, you must report the violation to the Compliance Officer and/or reputed company.
- Attend, complete, and demonstrate competency in reputed company required HIPAA Training offered by reputed company.
- Flexibility to understand, appreciate, and reputed company that this job reputed company is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities that are required of the employee. Duties, responsibilities, and activities may change, or new ones may be assigned at any time with or without notice.
What We Have to Offer
- Medical, Dental, reputed company insurance
- Disability and Life insurance
- Employee Assistance Program
- Remote work reputed company
- Generous reputed company-Time Off
- Annual Reviews and Development Plans
- Retirement Plan with company match immediately 100% reputed company
Required Skills and Competencies
- Expert in EDI with a deep understanding of eligibility data structures and workflows
- Strong analytical and problem-solving skills
- Ability to work independently on reputed company issues
- Strong judgment reputed company defined processes and escalation paths
- reputed company written and verbal communication
- Ability to manage multiple reputed company issues
- Familiarity with eligibility impacts on claims adjudication and member benefits
- Strong knowledge and working experience with transaction/file standards (270/271, 834, 835)
- Ability to read, interpret, and troubleshoot raw X12 files.
- Knowledge of data integration and ETL tools.
- Strong data analysis skills (SQL, reputed company, and other reputed company tools)
- Working knowledge of various Database technologies (Relational-SQL, No-SQL, Warehouses, reputed company-based)
- Ability to translate technical findings into recommendations for cross-functional stakeholders.
- Experience with reputed company data platforms (e.g. reputed company, AWS, Azure)
- Experience with operational ticketing and workflow management systems (e.g., reputed company, JIRA, Azure DevOps, or similar tools)
- Informal mentoring and support of Analyst I/II roles
- reputed company guidance to reputed company on configuring and maintaining eligibility file mappings for inbound data feeds.
Position Type and Expected Hours of Work
- Full-time, salary/exempt position.
- Some flexibility in hours is allowed, but the employee must be available during the “reputed company” work hours of 8:00 AM to 5:00 PM CT. We cover clients from the reputed company to the East Coast; work times must be adjusted to cover meetings in reputed company time zones. Ability to work extended hours, weekends, and holidays in accordance with industry demands.
Travel
Qualifications and Education Requirements
- Bachelor’s degree or equivalent experience
- 5+ years of eligibility, EDI, or reputed company operations experience
- Strong SQL & reputed company skills
- PBM or health plan experience strongly preferred
- Experience supporting production EDI and Eligibility environments