Eligibility Analyst I

MedImpact Healthcare Systems; San Diego (CA); On-site; USD 31,000 - 49,000; Full time

Job summary

MedImpact Healthcare Systems, Inc. seeks an Eligibility Analyst I in San Diego, CA to serve as a liaison between Account Management and the Eligibility Department.

You will perform quality assurance validation, verify file-load accuracy, and monitor processing to ensure timely and compliant eligibility data. Qualifications include a BS/BA and 1+ years of experience, plus strong data analysis skills and proficiency with Microsoft Office and healthcare software such as Pharmscreens, EPSROI, and

Qualifications

• BS/BA and 1+ years' experience or equivalent combination of education and experience.
• Data analysis experience preferred and healthcare eligibility experience a plus.

Responsibilities

• Perform quality assurance validation of eligibility file loads to verify data integrity and adherence to processing requirements.
• Remediate eligibility record exceptions to resolve data discrepancies and support accurate downstream processing.
• Coordinate with Account Management to validate file requirements and ensure timely eligibility file ingestion.
• Provide day-to-day operational production support for Account Management and act as SME for strategic partners.
• Drive improvements for error log handling, re-processing of failed member records, and automated file monitoring and alerts.

Skills

Data analysis

Communication

Problem solving

Attention to detail

Education

BS/BA in related field

Tools

Pharmscreens

EPSROI

COB File Manager

Microsoft Office

Job description

Exemption Status:

United States of America (Non-Exempt)

$22.24 - $28.90 - $35.57

"Pay scale information is not necessarily reflective of actual compensation that may be earned, nor a promise of any specific pay for any selected candidate or employee, which is always dependent on actual experience, education, qualifications, and other factors. A full review of our comprehensive pay and benefits will be discussed at the offer stage with the selected candidate."

This position is not eligible for Sponsorship.

MedImpact Healthcare Systems, Inc. is looking for extraordinary people to join our team!

Why join MedImpact?

Because our success is dependent on you; innovative professionals with top notch skills who thrive on opportunity, high performance, and teamwork. We look for individuals who want to work on a team that cares about making a difference in the value of healthcare.

Job Description

Summary

The Eligibility Analyst I serves as a liaison between Account Management and the Eligibility Department and processes daily client eligibility files. The role performs quality assurance validation to verify file-load accuracy, data integrity, completeness, and adherence to processing requirements; analyzes and remediates record exceptions; and monitors file activity and errors to ensure timely and accurate ingestion. This position collaborates with internal stakeholders to validate requirements, resolve processing issues, and drive issue resolution through strong business acumen and communication skills.

Essential Duties and Responsibilities

Essential Duties and Responsibilities include the following. Other duties may be assigned.

• Accountable for Performance Guarantees.
• Assisting in Audits and Sox Compliance.
• Accountable for overseeing and quality review of the Eligibility file loads.
• Performs quality assurance validation of eligibility file loads to verify data integrity, completeness, and adherence to established processing requirements.
• Analyzes and manually remediates eligibility record exceptions to resolve data discrepancies and support accurate downstream processing.
• Coordinates with Account Management to validate file requirements, resolve processing issues, and ensure timely and accurate eligibility file ingestion.
• Performs research and more complicated cleanup activities related to eligibility and synchronization issues with appropriate parties.
• Provides primary day-to‑day operational production support for Account Management, becoming the centralized eligibility Subject Matter Expert (SME) for these strategic partners.
• Drives technical system enhancements for error log handling, failed member record re‑processing on behalf of clients, and automated file monitoring and alerts in collaboration with IT Data Exchange.
• Writes and maintains detailed reference documentation in support of eligibility.
• Oversees verification of TPAs and Commercial Carriers batch file processing requests are completed, validating file delivery status or manually posting file(s) to secure FTP directories.

Supervisory Responsibilities

No supervisory responsibilities

Education and/or Experience

BS/BA and 1+ years' experience or equivalent combination of education and experience

Computer Skills

To perform this job successfully, an individual should have intermediate to advanced knowledge of Microsoft Office Suite. Experience using business applications such as Pharmscreens, EPSROI, COB File Manager required following training.

Certificates, Licenses, Registrations

None required

Other Skills and Abilities

Data analysis experience preferred and healthcare eligibility experience a plus.

Reasoning Ability

Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.

Mathematical Skills

Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs. Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.

Language Skills

Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to effectively present information in one‑on‑one and small group situations to customers, clients, and other employees of the organization.