Overview
Skills
Job Details
3-6 month Contract to Hire
W2 consultants ONLY
No 3rd party consultants
Must be eligible for hire without sponsorship
Must live in DE, PA or NJ and be commutable to 19103, 40 mile radius
Must have:
Deep Expertise in EDI & Enrollment Systems
- Strong working knowledge of EDI transactions (ANSI 834, alt 834, XML, HIPAA X12).
- Proven experience managing and troubleshooting inbound enrollment file activity and reconciliation processes.
- Ability to interpret and resolve complex pre-edit/post-release file issues
Healthcare Industry Experience
- Minimum 5 years in healthcare operations or enrollment systems, with understanding of how data flows between vendors, compliance teams, and client implementations.
- Familiarity with Health Rules or similar platforms is a plus.
Process Improvement & Change Management
- Demonstrated ability to analyze workflows, identify inefficiencies, and implement automation or process enhancements (including RPA).
- Proven experience leading cross-functional initiatives to improve quality and efficiency.
Responsibilities:
Lead reconciliation efforts for Core Enrollment Operations to ensure that key systems are updated.
Review complex inbound 834 and alt 834 file issues in pre-edit/post-release to develop best practices for analysis, reconciliation, and resolution.
Responsible for identifying process improvement opportunities that can enhance quality and efficiency without sacrificing service.
Liaison between Core Enrollment Operations and Vendors/UST/SDS/BTS/Compliance/Marketing/Client Implementation for enrollment impacting initiatives.
Act as subject matter expert for group requests and coordinate technical/process changes.
Document/prioritize system limitations and coordinate with BTS to identify technical solutions or automation opportunities.
Successfully manage the flow of inbound EDI files for client business.
Develop and document procedures/job aides/service alerts/policies for enrollment processes.
Manage initial enrollment file loads for new client installations.
Assist and train team members as needed.
Manage team inventory activity.
Lead enrollment related issues resolution for Enrollment Resolver Group.
Organize/disperse team project work for other team members.
Work on ad-hoc projects as requested.
Responsible for managing all robotic process automation (RPA) work for the business area.
Other duties assigned by the Leadership Team.
Knowledge, Skills, Abilities
Ability to work and coordinate enrollment process and Analytics for Core Enrollment Operations.
Represent Core Enrollment Operations during customer integration projects, operational meetings between divisions, new implementations, integration and new product development, key control audits, regulatory examinations, interaction with Health Edge (or other vendors).
Acute knowledge of EDI & enrollment systems. Understanding of XML/ANSI 834/HIPAA X12 transactions is required.
Must possess the ability to interface with internal/external customers at various levels.
Demonstrate experience in training & development.
Willingness to work in a fast-paced, challenging environment.
Detail oriented and organized, with exceptional prioritization skills.
Ability to effectively communicate with senior management, supervisors, peers, and clients.
Proficient in Microsoft Applications.
Proven process improvement methodology and driving change management.
Requires an extensive knowledge of EDI Portal functionality and managing inbound EDI enrollment file activity.
Experience in the Health Rules system platform, understanding of the Front Office System and how these platforms interact with EDI Portal for EDI enrollment validation preferred but not required.
Education & Experience
BA/BS Degree in Business related field or equivalent work experience preferred.
Minimum of 5 years experience in healthcare.
Scope:
Has in-depth knowledge in own discipline and basic knowledge of related disciplines.
Solves complex problems; takes a new perspective on existing solutions.
Works independently; receives minimal guidance.
Resource for colleagues with less experience.