Note: The job is a remote job and is open to candidates in USA. Lumen Solutions Group Inc. is a technology consulting services company supporting clients with IT consulting, staffing, strategy, and transformation services. The Functional Analyst will analyze, validate, test, reconcile, and audit EDI 834 eligibility files and Facets data, while supporting enrollment, production implementations, documentation, and process improvement initiatives.
Responsibilities
- Review and validate EDI 834 eligibility file layouts, specifications, and data
- Perform data analysis, testing, reconciliation, and auditing of eligibility files
- Validate vendor files against business and system requirements before production
- Reconcile eligibility data with claims/member data to identify discrepancies
- Support QA/testing, enrollment processes, and production implementations
- Analyze operational processes, identify gaps, and recommend improvements
- Gather requirements, document processes/SOPs, and prepare reports and analysis
- Monitor KPIs and support business/operational improvement initiatives
Skills
- Mandatory: EDI 834 Eligibility experience with strong knowledge of the 834 file layout
- Mandatory: Facets experience preferably Facets G6; Facets Legacy is also acceptable
- Experience with eligibility file data analysis, testing, validation, and reconciliation
- Strong analytical, problem-solving, documentation, and communication skills
- Advanced Excel and data analysis skills
- Bachelor's degree or equivalent experience
- 4+ years Functional Analyst experience or 6+ years operational/analytical experience
- Location: Baltimore, MD (Remote - Required Once in a Quarter)
- Healthcare payer/claims/enrollment experience strongly preferred
Benefits
- Remote work, with on-site attendance required once per quarter
Company Overview