Enrollment Analyst

Neighborhood Health Plan of Rhode Island; Smithfield (RI); On-site; USD 50,000 - 65,000; Full time

Job summary

Neighborhood Health Plan of Rhode Island is seeking an Enrollment Analyst to manage eligibility and enrollment functions, including processing EDI files, analyzing error reports, and identifying solutions to ensure data accuracy and integrity. The role collaborates with management and external partners to support the organization’s mission and values.

The ideal candidate will handle enrollment data with precision, conduct EDI reviews, generate Cognos and enrollment activity reports, and

Qualifications

• High School diploma or GED.
• 3–5 years Health Plan/HMO enrollment experience preferred.
• 1 year experience with EDI process and 834 enrollment preferred.
• Excellent organizational, problem-solving and analytical skills.
• Strong verbal and written communications skills.
• Proficiency in Microsoft Office Suite.

Responsibilities

• Processes enrollment data for membership with accuracy; research membership eligibility via contract review and benefit criteria.
• Analyzes data on EDI files by converting files and running macros to identify members needing updates and ensure eligibility reconciliation.
• Completes EDI reviews, identifies discrepancies and researches processing solutions.
• Generates Cognos reports and coordinates updates with Business Analytics to increase department efficiency.
• Generates enrollment activity reports for internal and external customers.
• Analyzes error reports and trends from 834 files against delegated entity membership.
• Provides EDI oversight of delegated entities for 834 file reviews.
• Communicates with EOHHHS, DCYF, HSRI, and HP to resolve enrollment issues.
• Handles all functions related to Benefit Coordination, Outreach, Reporting and disenrollment; seeks workflow improvements.

Skills

Analytical skills

Communication skills

Organizational skills

MS Office

Team player

Education

High School diploma or GED

Associate degree in Business or Health related area

Tools

EDI power reader

Map Force

Cognos Reporting

Excel

Job 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

• 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

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

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.