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 failing 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 about 40% in year-over-year revenue growth in 2018. Are we recognized? Definitely. We have been named one of “Becker’s 150 Great Places to Work in Healthcare” in 2016, 2017, 2018 and 2019, and One of the “50 Great Places to Work” in 2017 by Washingtonian. We recognize employees that live our values, give back to our communities each year, and are champions for bringing our whole selves to work each day. 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.
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) and our Commercial partners
- Act as a trading partner liaison with our client partners to foster communication between business/IT teams, developers and external stakeholders.
- Identify, document and analyze discrepancies and anomalies within automated data reconciliation and disputed 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):
- Must have a Bachelor’s degree preferably with a quantitative or healthcare major
- 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
- Must have experience with SQL (advanced/2-5 years) and Microsoft Excel (advanced/2-5 years)
- 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
- Independent thinker with the ability to multitask and manage multiple projects with varying timelines
- Willingness to develop and explore new approaches, adapt, and execute quickly and be comfortable with ambiguous project outlines
- Exceptionally strong analytical abilities, with track record of identifying insights from quantitative and qualitative raw data in varied formats requiring manipulation
- Excellent interpersonal, oral and written communication skills
- Able to work independently and within a collaborative team environment with little guidance/supervision
Finishing Touches (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)
- Experience with EDI X12 structure and syntax rules; chiefly with 834 files
- Superior root cause analysis skills, including corrective action planning and ability to provide documentation to support analysis
Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin.