Enrollment Analyst

Location: Smithfield, RI (On-site)

The Enrollment Analyst is responsible for all eligibility and enrollment functions related to membership enrollment and disenrollment including the processing of Electronic Data Interchange (EDI) files, analyzing error reports and trends ands and identifying solutions to ensure data accuracy and integrity.

This position presents an integrated view of enrollment with all levels of Management and external partners while supporting the mission, vision, and value of the organization.

Duties and Responsibilities:

Responsibilities include, but are not limited to, the following:

• Processes enrollment data for membership with accuracy which may include 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, identify discrepancies and research processing solutions.
• Generates Cognos reports and recommend updates for additional Cognos reporting through 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.

Additional responsibilities include:

• Perform quality audits for enrollment changes to maintain data integrity. This includes reporting births to EOHHA and COB
• Train new staff members and non-enrollment staff as required

• Performs other duties as assigned
• Corporate Compliance Responsibility - As an essential function, responsible for complying with Neighborhoods Corporate Compliance Program, Standards of Business Conduct, applicable contracts, laws, rules and regulations, policies and procedures as it applies to individual job duties, the department, and the Company. This position must exercise due diligence to prevent, detect and report unlawful and/or unethical conduct by fellow co-workers, professional affiliates and/or agents

Qualifications

Required:

• High School or GED
• 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 communications 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

Preferred:

• Associates degree in Business or Health related area
• Experience working with EDI and/or 834 files

Core Company-Wide Competencies:

• Communicate Effectively
• Respect Others & Value Diversity
• Analyze Issues & Solve Problems
• Drive for Customer Success
• Manage Performance, Productivity & Results
• Develop Flexibility & Achieve Change

Job Specific Competencies:

• Collaborate & Foster Teamwork
• Influence & Negotiate
• Attend to Detail & Improve Quality
• Exercise Sound Judgement & Decision Making

FDR Oversight:

• Business Lead Level:

In the role of business lead for assigned FDR; incumbent is responsible to complete comprehensive oversight and monitoring of their vendor that incorporates the following elements: efficient and effective operations; compliance with laws, regulations, policies, procedures; and other company performance issues designed to reduce risk and add value to the company

Neighborhood Health Plan of Rhode Island is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.