Note: The job is a remote job and is open to candidates in USA. SummaCare provides Medicare Advantage, individual and family, and commercial insurance plans in Ohio. The Enrollment EDI Analyst develops, implements, and monitors electronic data interchange transactions related to membership and enrollments, including eligibility, enrollment, premium billing, and reconciliation activities.
Responsibilities
- Develops, implements processes and monitors all EDI transactions as it pertains to membership/enrollments
- Ability to communicate instructional and operational information verbally and in written form that may include correspondence, reports, instructional materials, system designs; ability to provide instruction and guidance required to supervise day-to-day departmental operations; ability to interface with internal staff, mid-upper management professionals and general public
- Collecting, analyzing data from diverse sources; making recommendations and/or conclusions based on analyses; developing financial, data processing technical reports, procedures, systems that usually affect one department
- Demonstrate high degree of organization and attention to detail
- Demonstrate excellent technical skills with the desire and ability to learn new software programs and systems
- Demonstrate initiative and ability to work autonomously in a self-directed manner, and transition easily between working alone and working with groups
- Operate standard office machines
- Organize and manage time to accurately complete tasks within designated time frames in a fast- paced environment
- Maintain current knowledge of and comply with regulatory and company policies & procedures
- Maintain confidentiality of patient and business information
- Flexible: ability to adjust wok hours to meet business demands
- Ability to effectively interact with populations of patients/customers with an understanding of their needs for self-respect and dignity
- Sit for prolonged periods of time
- Bend, stoop, and stretch
- Manual dexterity to operate computer, phone, and standard office machines
Skills
- A. Associates Degree or may substitute with 2 years of like experience
- A. 3+ years performing same or similar responsibilities. Relevant experience includes: eligibility, enrollment, premium billing, and/or reconciliation responsibilities in a managed care environment, and/or working knowledge of electronic enrollment transactions and 834 files
- A. Ability to communicate instructional and operational information verbally and in written form that may include correspondence, reports, instructional materials, system designs; ability to provide instruction and guidance required to supervise day-to-day departmental operations; ability to interface with internal staff, mid-upper management professionals and general public
- B. Collecting, analyzing data from diverse sources; making recommendations and/or conclusions based on analyses; developing financial, data processing technical reports, procedures, systems that usually affect one department
- C. Demonstrate high degree of organization and attention to detail
- D. Demonstrate excellent technical skills with the desire and ability to learn new software programs and systems
- E. Demonstrate initiative and ability to work autonomously in a self-directed manner, and transition easily between working alone and working with groups
- F. Operate standard office machines
- G. Organize and manage time to accurately complete tasks within designated time frames in a fast- paced environment
- H. Maintain current knowledge of and comply with regulatory and company policies & procedures
- I. Maintain confidentiality of patient and business information
- J. Flexible: ability to adjust wok hours to meet business demands
- K. Ability to effectively interact with populations of patients/customers with an understanding of their needs for self-respect and dignity
- A. Sit for prolonged periods of time
- B. Bend, stoop, and stretch
- C. Manual dexterity to operate computer, phone, and standard office machines
Benefits
- Remote Opportunity
- Medical insurance
- Dental insurance
- Vision insurance
- Life insurance
- Paid time off
- Basic Life and Accidental Death & Dismemberment (AD&D)
- Supplemental Life and AD&D
- Dependent Life Insurance
- Short-Term and Long-Term Disability
- Accident Insurance, Hospital Indemnity, and Critical Illness
- Retirement Savings Plan
- Flexible Spending Accounts – Healthcare and Dependent Care
- Employee Assistance Program (EAP)
- Identity Theft Protection
- Pet Insurance
- Education Assistance
- Daily Pay
Company Overview