It’s Time For A Change…
Your Future Evolves Here
Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and moving forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans. Are we growing? Absolutely—56.7% in year-over-year revenue growth in 2016. Are we recognized? Definitely. We have been named one of “Becker’s 150 Great Places to Work in Healthcare” in 2016 and 2017, one of the “50 Great Places to Work” in 2017 by Washingtonian, and our CEO was number one on Glassdoor’s 2015 Highest-Rated CEOs for Small and Medium Companies. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.
Evolent Health is looking for a Senior Analyst, Enrollment and Billing to be a key member of our Medicare Advantage Operations team. Reporting to the Director of Medicare Operations, this individual will play a critical role in executing Evolent Health’s mission by managing and overseeing the overall operations of the Medicare Enrollment and Premium Billing unit. The Sr. Manager will be responsible for managing staff to ensure enrollment and billing transactions are processed accurately, within regulatory timeframes and individual performance goals while adhering to department, industry and productivity standards. This position will act as the liaison with both departmental and organizational business partners as well as external clients and vendors as it relates to the Plan’s Enrollment, Eligibility and Premium Billing standards and workflows and to resolve service barriers, develop solutions to improve effectiveness and identify continuous improvement initiatives to increase service levels.
What You’ll Be Doing:
- Partner with IT and business stakeholders as well as external trading partners to successfully implement a mix of initiatives ranging from functional enhancements and continuous improvements.
- Define business requirements and acceptance criteria/test cases related to programs facilitated by the Centers for Medicare and Medicaid (CMS)
- Review regulatory and policy changes from CMS programs, particularly the Federal Exchange and Medicare Advantage
- Act as a trading partner liaison with federal and state-based health insurance exchanges to foster communication between business/IT teams, developers and external stakeholders.
- Identify, document and analyze discrepancies and anomalies within automated data reconciliation and issuer dispute data
- Develop a deep understanding of the business rules, and leverage that knowledge to improve processes, recommend solutions, enhance team performance, and drive progression of client objectives
- Utilize a variety of software and platforms for statistical analysis and research concerning data
- Create and standardize solutions and workflows.
- Perform business analysis of identified process and software gaps or inefficiencies and develop plans to fill those gaps for internal business processes and for external clients.
- Perform requirements review with external and internal stakeholders and obtain sign off from all required individuals.
- Identify and document system deficiencies and recommends solutions.
The Experience You’ll Need (Required):
- Extensive knowledge in health insurance third party administrator concepts for commercial, federal and state government plans specifically supporting operational processes for enrollment and eligibility processing, member benefits, and EDI Interfaces
- Experience with EDI X12 structure and syntax rules; chiefly with 834 files
- Knowledge of the Affordable Care Act, HMO and managed care principles including Medicaid and Medicare regulation.
- Solid aptitude of compiling data from many sources and defining designs for enrollment to benefit plan configuration.
- Strong analytical capabilities to understand data sets to derive business conclusions while identifying anomalies based on business rules
- Research, interpret and summarize new state, federal and client rules regarding department functions. Alter or create policies and procedures to adhere to those rules.
- Robust time management, attention to detail, analytic and organizational skills.
- Excellent interpersonal, oral and written communication skills.
- Able to work independently and within a collaborative team environment with little guidance/supervision.
Finishing Touches (Preferred):
- Associate or bachelor’s degree preferred.
- 3-5+ years of IT and/or business experience in an HMO/PPO Claims, Medicaid, Medicare and/or managed care healthcare environment
- Extensive experience with the System Design Life Cycle (SDLC).
- Superior root cause analysis skills, including corrective action planning and ability to provide documentation to support analysis.
- Demonstrated breadth and depth of experience regarding data analysis/reconciliation
- Ability to read and understand SQL