Enrollment Data Analyst II Nashville TN

Company Name:
UniCare Life & Health Insurance Company
Job Description
Amerigroup , a proud member of the WellPoint family of companies,is focused on serving Medicaid, Medicare and uninsured individuals and families. We improve access to quality health care for the financially vulnerable, seniors and people with disabilities. Here, you can do work that matters and offers opportunities for personal and professional growth. Together, our associates are transforming health care with trusted and caring solutions.

_Enrollment Data Analyst II - Nashville, TN - #_
Re
sponsible for routine maintenance, updates and reconciliation of enrollment databases for assigned markets, and resolution of fundamental enrollment issues. Analyzes and resolves moderate to complex errors resulting from automated file updates. Performs quality assurance functions for assigned market/client database and communicates issues to the Health Plan.
1. Maintains and updates Enrollment Profiles for assigned markets, often requiring high volume data entry. Updates occur through regularly scheduled automated file loads and manual requests received through Member Services, the client and/or Health Plan.
2. Monitors receipt of State enrollment files, and communicates issues to management.
3. Updates enrollment applications from State eligibility files.
4. Responds to enrollment verification requests, and updates applications accordingly.
5. Researches and resolves eligibility inquiries, verifying basic enrollment/eligibility information and ensuring that the enrollment database reflects correct data.
6. Interfaces with appropriate Health Plan, State and AMERIGROUP representatives, as needed.
7. Analyzes and resolves moderate to complex errors resulting from automated enrollment updates.
8. Reviews and analyzes reports generated from automated file loads. 9.Responds to phone/contact log requests.
9. Assures appropriate Primary Care Physicians (PCPs) are assigned either through the automated auto assignment process or by manual selection.
10. Reviews and works returned mail.
11. Prepares monthly membership lists for contracted providers and vendors.
12. Performs monthly reconciliation of State files to Enrollment database.
13. Produces and analyzes various quality assurance reports.
14. Researches and resolves membership discrepancies identified through monthly quality reports and the Premium Reconciliation application.
15. Maintains compliance with HIPAA, Sarbanes-Oxley (SOX) and other internal controls in all processes, and alerts management to potential risks.
16. Meets or exceeds individual productivity metrics, quality and timeliness standards as defined by department guidelines.
17. Assists other Enrollment Analysts as assigned.
Job Qualifications
Requires a High school diploma.
Associates Degree in Business, Healthcare or related field preferred.
Requires 2-3 years experience in analytical role, analyzing data from available resources (i.e. state website, enrollment files, and database) in order to make decisions regarding member eligibility.
Healthcare industry experience; knowledge of membership database and benefit structures preferred.
Knowledge and experience using management information systems, Microsoft Outlook, Word, Excel, and Access database.
Demonstrated ability to analyze data from available resources (i.e. state website, enrollment files, and database) in order to make decisions regarding member eligibility.
Working knowledge of AMISYS and/or FACETS, or similar adjudication system preferred.
Excellent verbal and written communication skills required.
Detail oriented with good problem solving skills.
Ability to manage multiple tasks in a demanding work environment.
_WellPoint is ranked as one of Americas Most Admired Companies among health insurers by Fortune magazine, and is a 2013 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company please visit us . EOE.M/F/Disability/Veteran._
Once an offer is accepted, all external applicants are subject to a background investigation and if appropriate, drug testing. Offers of employment shall be contingent upon passing both the background investigation and drug testing (if required).
Current WellPoint associates: All referrals must be submitted through the formal associate referral process on WorkNet. Official guidelines for the associate referral program can be found in My HR.

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