Enrollment Analyst

Job Details

Job Location

Smithfield, RI - Smithfield, RI

Position Type

Full Time

Education Level

High School or GED

Travel Percentage

Occasional

Job Shift

Daytime

Job Category

Some Experience

Description

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 :

Qualifications

Qualifications

Required :

Preferred :

Core Company-Wide Competencies :

Job Specific Competencies :

FDR Oversight :

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

Salary Grade : D

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.