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Neighborhood Health Plan of Rhode Island · 2 days ago

Enrollment Analyst

Smithfield, RI

Full-time

Onsite

Mid Level

3+ years exp

Neighborhood Health Plan of Rhode Island is seeking an Enrollment Analyst responsible for all eligibility and enrollment functions related to membership. The role involves processing enrollment data, analyzing EDI files, and ensuring data accuracy while supporting the organization's mission and collaborating with various departments.

Health CareMedicalNon Profit

H1B Sponsor Likely

Responsibilities

Processes enrollment data for membership with accuracy which may include researching membership eligibility through contract review and benefit criteria requirements

Analyzes data on Electronic Data Interchange (EDI) files by converting files through EDI power reader or Map Force into excel, and running macros to identify which members require updates and ensure eligibility reconciliation

Completes EDI reviews, identify discrepancies and research processing solutions

Generates Cognos reports and recommend updates for additional Cognos reporting through Business Analytics team to increase department efficiencies

Generates enrollment activity reports for both internal and external customers

Analyzes error reports and trends from 834 files against delegated entity membership

Provides FDR Eligibility oversight of delegated entities for EDI review through conversion of 834 files into readable format

Communicates with Executive Office of Health & Human Services (EOHHS); Department of Children, Youth & Family Services (DCYF); Health Source RI (HSR) and HP on a daily basis to resolve enrollment issues

Handles all functions related to Benefit Coordination, Outreach, Reporting and member disenrollment while identifying process improvement and workflow efficiencies

Perform quality audits for enrollment changes to maintain data integrity. This includes reporting births to EOHHA and COB

Train new staff members and non-enrollment staff as required

Performs other duties as assigned

Corporate Compliance Responsibility - As an essential function, responsible for complying with Neighborhoods Corporate Compliance Program, Standards of Business Conduct, applicable contracts, laws, rules and regulations, policies and procedures as it applies to individual job duties, the department, and the Company. This position must exercise due diligence to prevent, detect and report unlawful and/or unethical conduct by fellow co-workers, professional affiliates and/or agents

Qualification

Health Plan/HMO experienceEDI process experienceData analysisMicrosoft Office SuiteAnalytical skillsOrganizational skillsProblem-solving skillsVerbal communicationWritten communicationTeam playerAttention to detailDecision making

Required

High School or GED

Minimum of 3-5 years Health Plan/HMO experience. Previous position in Enrollment strongly preferred

1 year experience with EDI process and 834 benefit enrollment strongly preferred

Excellent organizational, problem-solving and analytical skills

Strong verbal and written communications skills for interaction with internal and external clients

Experience working independently, and as a team player while handling multiple responsibilities and meeting timelines

Previous experience analyzing data and developing reports

Proficiency in Microsoft Office Suite

Preferred

Associates degree in Business or Health related area

Experience working with EDI and/or 834 files

Company

Neighborhood Health Plan of Rhode Island

Neighborhood Health Plan of Rhode Island offers nationally-recognized, high-quality health care for 185,000 Rhode Islanders.

Founded in 1993

Providence, Rhode Island, USA

201-500 employees

https://www.nhpri.org

H1B Sponsorship

Neighborhood Health Plan of Rhode Island has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

Represents job field similar to this job

Trends of Total Sponsorships

2025 (1)

2024 (7)

2023 (1)

2022 (3)

2021 (4)

2020 (4)