Analyst, Data Exchange - Eligibility
New
J
Judi HealthHealth Technology
Remote (For Non-Local) or Hybrid (Local to Denver, CO or NYC area)Full-TimeMiddle
Salary76,800 - 121,000 USD per year
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Job Details
- Experience
- 1+ years
- Required Skills
- SQLData AnalysisMicrosoft ExcelJSON
Requirements
- Bachelor’s degree
- 1+ years of previous work experience, preferably in PBM, Healthcare, Data Exchange, and Eligibility
- Ability to match key PBM concepts and data fields across various systems and file layouts
- Ability to analyze complex business problems to discover root causes
- Proficiency in SQL, Excel, JSON
- Strong communication skills
- Self-motivated and detail-oriented problem solver
- Ability to handle multiple competing priorities in a dynamic environment
Responsibilities
- Attend new client implementation meetings with external partners to discuss eligibility requirements and protocols
- Recommend eligibility file formats to external partners and coordinate receipt and processing of eligibility data
- Acting as a healthcare data subject matter expert on Eligibility guidelines and Electronic Data Interchange (EDI) protocols
- Serving as a point of coordination for member eligibility issue identification and issue resolution with internal teams and external partners
- Identify and triage eligibility issues and support the resolution of all errors related to transferring, loading, and management of eligibility data
- Proactively monitoring system status and eligibility data to quickly identify potential abnormalities
- Ensuring that all issues and errors are resolved using designated operating standards
- Assist with the validation of eligibility data integrity through regular audits and reconciliation processes
- Ensure accurate and timely entry of group/plan structure determinations for benefits and enrollment
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