Eligibility File Analyst bei Leading Edge Administrators LLC

Description

Job Summary:
The Eligibility File Analyst is responsible for providing support to clients and internal team partners before, during and after the implementation of a client’s electronic enrollment file, specific to the EDI (Electronic Data Interchange) HIPAA 834 5010. This includes responsibility for managing the documentation and implementation of clients' requests as well as other types of electronic data files. This role supports the overall enrollment and eligibility processes for the team and acts as a liaison and problem-solver for electronic file (EDI 834) customers and other areas of the enrollment and eligibility process.
 

Duties and Responsibilities:

• Project manage implementation of the various electronic enrollment options (EDI 834, proprietary spreadsheet or other solutions).
• Consult with client or their designated vendor during the implementation process to determine any special processing and system requirements to implement an automated enrollment process.
• Develop and conduct testing of file implementations; as the main point of contact, coordinate and communicate internally and externally until fully implemented with ongoing support for problem resolution.  
• Audit inbound and outbound files; reconcile errors and findings. Make decisions based on analysis for problem resolution, downstream impact mitigation and improved efficiency.
• Analyze impact of new benefits/products and other business needs on existing manual and automated processes and propose alternatives. Develop and design solutions to customer business problems and requirements. Quantify the cost and business benefits of the alternative solutions and make recommendations. Develop user requirements to propose the most feasible, cost-effective solution to address the request and promote continuous improvement.
• Recommend procedure and system changes to provide a more effective and efficient electronic enrollment process.
• Develop complete and accurate project documentation and implement training programs/materials to assist customers and stakeholders in adapting to system modifications.
• Guide and assist in the training of other team members to develop a thorough knowledge of the role including tasks and client requirements.
• Approve systems and procedure changes to increase automation or improve processing accuracy or timeliness. This can include system release testing, UAT testing, test case creation and the execution of the testing.

Requirements

Required Knowledge, Skills, and Abilities:

• Bachelor’s degree in business administration, healthcare administration, information systems technologies, or computer science preferred
• 3+ years of experience in benefits eligibility, enrollment, or implementation role processing 834 and other enrollment file types, preferably in a TPA
• In depth knowledge of the HIPAA EDI 834 5010 file layout as well as other data exchange files, .XML, file segments and concepts; health insurance plans, employee benefits, and COBRA coverage.
• Demonstrated history of creating process documentation and contributing to improvement in healthcare role(s).
• Experience with Notepad++ or similar platform preferred
• Solid working knowledge of standard computer applications including MS Word, Excel, Outlook, and PowerPoint
• Ability using a computer which includes expert keyboard and navigation skills and learning new programs
• Communicate clearly and professionally with internal and external customers
• Work effectively individually and as part of a team to achieve established outcomes. Understand other’s roles and empower one another to take responsibility to be successful.  
• Demonstrate collaborative interactions with peers to reach a common goal as well as be a resource to team members and internal/external customers
• Pay close attention to detail in all aspects of the job
• Make decisions using available resources and sound judgment 
• Maintain confidentiality and discretion
• Identify and resolve problems in a timely manner, gather and analyze information skillfully and proactively
• Share knowledge with associates by effectively communicating and providing follow-up
• Open to other’s ideas and exhibits a willingness to try new things
• Demonstrate accuracy and thoroughness; monitor work to ensure quality
• Prioritize and plan work activities to use time efficiently
• Adapt to changes in the work environment, manage competing demands and is able to deal with frequent changes, delays, or unexpected events
• Follows instructions, responds to direction, and solicits feedback to improve
• Act in such a way to instill trust from management, other associates, as well as customers

Physical and Cognitive Demands: The demands described here are representative of those necessary for an employee to successfully perform the essential functions of this job. Reasonable accommodation can be made to enable individuals with disabilities to perform the essential functions.

• Constant: Talk, hear, speak, and use hands and fingers to operate a computer, telephone, keyboard/mouse; occasionally move about the office
• Constant: Visual ability such as close vision, distance vision, color and peripheral vision, depth perception and ability to adjust focus; ability to detect differences in color shades and brightness
• Occasional: Lift and/or move up to 10 pounds
• Constant: Regular, predictable attendance is required
• Constant: While performing the duties of this job, the employee is regularly sitting for the full shift.
• Constant: The cognitive skills needed to complete tasks include abilities such as learning, remembering, focusing, categorizing, and integrating information for decision making, problem-solving, and comprehending. 

Work Environment: The work environment described is representative of what must be met by an employee successfully to perform the essential functions of this job.  

• The physical environment is indoors in a controlled climate, office setting. The noise level may be low to moderate.

The duties described are representative, but not restrictive of tasks that may be assigned or of the abilities required to do the job. The description is subject to change at any time. Other related duties may be assigned. This description does not alter the at-will status of employment.

Pay may vary based on location. Offers will be adjusted based on an individual's experience, education, and other job-related factors as permitted by law. Pay range is: $70,000-105,000/year