Enrollment Data Analyst
New
Candidates must reside in the United States within the Central (CST) or Eastern (EST) time zone., Central (CST) or Eastern (EST)Full-TimeMiddle
Salary not disclosed
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Job Details
- Experience
- 2+ years
- Required Skills
- SQLData AnalysisHIPAA
Requirements
- 2+ years of experience in health plan enrollment operations, managed care, or EDI data processing.
- Hands-on experience with HIPAA 834 transaction processing and X12 EDI standards.
- Proficiency with SQL for data retrieval, validation, and correction.
- Experience working within claims administration systems (e.g., Plexis QC, QNXT, TriZetto, HealthEdge).
- Strong attention to detail and ability to manage high volumes of data.
- Familiarity with ACA eligibility and enrollment rules, CMS guidelines, and HIPAA data privacy.
Responsibilities
- Configure, monitor, and troubleshoot inbound and outbound HIPAA 834 transaction files.
- Validate 834 file structures for compliance with X12 5010 standards.
- Perform systematic validation of member enrollment records against source documents.
- Accurately enter and update member demographic and eligibility data.
- Lead targeted data cleanup projects using SQL queries.
- Partner with engineering and claims teams to address downstream enrollment data issues.
- Support compliance and reporting requirements including ACA 1095-B and CMS submissions.
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