Customer Solution Center Enrollment Analyst II

Job Summary

The Customer Solution Center Enrollment Analyst II is responsible for maintaining various databases and queries related to membership audit and error correction reports; collaborating closely with the Membership Information Supervisor, Senior Report Writers/Analysts, and various other internal and external stakeholders to implement new databases, queries, and reports (and update existing ones) to help facilitate the timely, accurate reflection of membership information for all lines of business in the systems, in accordance with regulatory and organizational guidelines; trouble-shooting inquiries from internal and external stakeholders regarding inbound and outbound files, etc. of membership information and collaborating closely with peers in I.T. for timely resolution;  meeting and exceeding quality and performance measurements, as required by the department and the organization to meet regulatory requirements; Participating in internal and external audits and serving as a subject matter expert for various internal and external committees, meetings, etc.

Duties

Maintain various databases and queries related to membership audit and error correction reports. Collaborate closely with the Enrollment Services Supervisor, Senior Report Writers/Analysts, and various other internal and external stakeholders to implement new databases, queries, and reports (and update existing ones) to help facilitate the timely, accurate reflection of membership information for all lines of business in the systems, in accordance with regulatory and organizational guidelines.  Ensure that I.T. is apprised of the impact of relevant system and data issues, the timely receipt and systematic update of the systems. Ensure that internal and external peers understand the need for timely, accurate submission of data and the impact that the delays, etc. have on member eligibility, access to care, receipt of health plan materials and notification letters, etc. Ensure that internal peers within and outside of the department understand the impact of their functions on member eligibility, access to care, receipt of health plan materials and notification letters, etc. and the related departmental processes, regulatory compliance, etc. (50%)

Trouble-shoot inquiries from internal and external stakeholders regarding inbound and outbound files, etc. of membership information and collaborating closely with peers in Information Technology I.T. for timely resolution. (30%)

Participate in internal and external audits and serving as a subject matter expert for various internal and external committees, meetings, etc. (10%)

Perform other duties as assigned. (10%)

Duties Continued

Education Required

Education Preferred

Experience

Required:

Minimum 2 years of experience in auditing, analyzing, and updating health care membership information, especially for the Medi-Cal, Medicare, Healthy Kids, and PASC-SEIU lines of business and generating and reviewing data queries and reports and a year of customer service experience, preferably with a health care organization. 

Experience with QNXT, MHC or other managed care legacy system.

Intermediate knowledge and experience with Hyperion, Microsoft Access and Excel.

Skills

Required:
Ability to operate PC-based software programs or automated database management systems.    

Ability to self-manage in a fast-paced, detail-oriented environment.

Strong analytical, problem-solving and multi-tasking skills.  

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Physical Requirements

Additional Information