Enrollment Analyst (45084)

Neighborhood Health Plan of Rhode Island; Smithfield (RI); On-site; USD 55,000 - 65,000; Full time

Job summary

Neighborhood Health Plan of Rhode Island is seeking an Enrollment Analyst in Smithfield, RI to manage eligibility and enrollment processing, including EDI file handling and data integrity.

You will analyze error reports, generate Cognos reports with the Analytics team, and support disenrollment, benefit coordination, and outreach while driving process improvements for accuracy and efficiency.

Qualifications

• High School or GED required.
• 3–5 years Health Plan/HMO experience.
• 1 year experience with EDI processes and 834 enrollment preferred.
• Excellent organizational, problem-solving and analytical skills.
• Strong verbal and written communication with internal/external clients.
• Experience working independently and as a team under deadlines.
• Experience analyzing data and developing reports.
• Proficiency in Microsoft Office Suite.

Responsibilities

• Process enrollment data for membership with accuracy.
• Analyze EDI files and identify updates and reconciliation needs.
• Complete EDI reviews and research discrepancies.
• Generate Cognos reports and support reporting improvements.
• Create enrollment activity reports for internal and external customers.
• Communicate enrollment issues with EOHH, DCYF, HSRI, and HP daily.
• Support Benefit Coordination, Outreach, Reporting and disenrollment processes.
• Train new staff as required.

Skills

Analytical skills

Communication skills

Teamwork

Data analysis

Education

High School or GED

Associates degree in Business or Health-related field

Tools

Microsoft Office Suite

Job description

Job Details: Job Location: Smithfield, RI - Smithfield, RI 02917, Position Type: Full Time, Education Level: High School or GED, Travel Percentage: Occasional, Job Shift: Daytime, Job Category: Some Experience, 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 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

• 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.