Enrollment Data Analyst – EDI & Reporting

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

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