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ENROLLMENT ANALYST - HOAG CLINIC CLAIMS & ENROLLMENT

Department:  Business Services
Status:  Full Time
Shift:  1st

Job Summary: 

Hoag Clinic is seeking an Enrollment Analyst responsible for maintaining accurate, timely, and current enrollment status across multiple systems. The Enrollment Analyst will analyze and reconcile enrollment data utilizing monthly enrollment files, error reports, and other data elements to ensure accuracy. The analyst will collaborate with internal departments such as Finance, UM and Member Services to resolve enrollment issues, PCP changes/discrepancies, capitation audits, and other processes as needed. 

 

Essential Functions

  • Analyzes data from several sources to determine eligibility changes and resolve enrollment or eligibility errors
  • Monitor and retrieve enrollment files from FTP site assuring all health plans are providing timely eligibility files
  • Downloads reconciliation results and performs the tracking, research and resolution of identified discrepancies
  • Tracks, organizes, and reviews all capitation revenue and membership received for reporting purposes
  • Assures compliance with operational and regulatory requirements for all enrollment and eligibility operations
  • Engages in membership eligibility research, requiring critical thinking skills and the ability to analyze and resolve payment discrepancies
  • Contributes to the development and documentation of reconciliation workflows and educational tools used to facilitate cross-training and internal controls
  • Work with cross-functional departments by providing support to IPA/PCPs as necessary; with an emphasis on front-line eligibility problem-solving.
  • Compile information from multiple data sources to prepare reports on a monthly, quarterly, and ad hoc basis
  • Contributes to promoting an atmosphere of team-orientation through demonstrating a positive, flexible, and customer service attitude
  • Perform support and other duties as needed.

 

Education, Training and Experience

 

Required:

  • Minimum of 3-5 years in customer service experience/reconciliation, auditing, accounting or analytics
  • High school diploma or general education degree. Bachelor's degree preferred.

 

Preferred:

  • Knowledge of Medicare Managed Care Plans
  • Bi-lingual (English/Spanish) preferred

 

 

Skills or Other Qualifications

 

Required:

  • Intermediate demonstrated analytical skills
  • Intermediate written and verbal communication skills
  • Ability to develop data requirements and work with teams and groups to extract, organize and analyze data and trends
  • Ability to define problems: collect data, establish facts, and draw valid conclusions to implement solutions
  • Ability to effectively present information and respond to questions from management and others
  • Self-motivated and takes initiative: identifies, acts on, and documents solutions for gaps and opportunities for process improvements
  • Ability to work independently and use critical thinking skills
  • Strong moral compass and commitment to Hoag’s values
  • Motivated to learn, continually improve and operate to one’s fullest potential
  • Positive attitude, a passionate, excited, strong desire to simplify processes
  • Experience in providing excellent customer service, empathetic ability
  • Excellent interpersonal and customer service skills
  • Basic knowledge of Managed Care Plans, Medi-Cal Managed Care Plans, and private insurance

 

Preferred

  • Typing skills 40-50 wpm

 

License and Certifications

 

Required: N/A

Preferred: N/A

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