Enrollment Analyst
Enrollment Analyst
Who are we?
Versant Health is one of the nation’s leading administrators of managed vision care, serving millions of our clients’ members nationwide. We are driven by our mission to help members enjoy the wonders of sight through healthy eyes and vision.
As a Versant Health associate, you can enjoy a comprehensive Total Rewards package, which includes health and dental insurance, tuition reimbursement, 401(k) with company match, pet insurance, no-cost-to-you vision insurance for you and your qualified dependents. We are also invested in your success. There are many opportunities for advancement and development throughout all stages of your career with us.
See how you can make a difference with the support of strong leadership and a team environment.
See Everything, Be Anything™.
What are we looking for?
The Enrollment Analyst is primarily responsible for the implementation, testing and management of customer electronic enrollment files and routine file processing. The Analyst will work with internal contacts, customers and trading partners in the establishment of new EDI files, and in the management and oversight of the daily EDI files received for processing.
Where you will have an impact
- Review daily distributions to determine what programming is required to establish/update electronic enrollment feeds.
- Complete, test, and validate all programming that is executed for each client against incoming test enrollment feed.
- End-to-end testing of all new and recently changed incoming electronic enrollment feeds; documentation of all results. Completion of testing in accordance with defined scenarios to ensure customer and file quality.
- Strong organization and time management skills to allow for implementation of client-proprietary file formats.
- Comprehensive knowledge of all inbound enrollment file types; ability to map all inbound files to Versant Health Standard layouts (DV280, DV2000).
- On-going analysis of any enrollment file concerns as they arise.
- Daily sort review, inclusive of all enrollment files to be processed for the day.
- Review Sort/Stack results and per SOC audit controls review files with large mismatch counts to determine if files should be run/pulled, interacting with customers and internal resources as necessary.
- Complete department tasks with attention to established SOC controls in accordance with defined expectations, monitoring weekly to ensure proper completion of tasks and retention of evidence of controls is completed.
- Manage files with attention to existing performance guarantees for file processing timeliness and accuracy. Performance Guarantee (PG) compliance is to be met for all files processed.
- Review all CVX staging reports to determine if files can be applied to or withheld from the production database.
- Prompt response to external and internal customer inquiries regarding EDI files, enrollment updates or concerns that exist.
- Required to document and account for any client enrollment files that are withheld from production per defined process and controls in place.
- Weekly review of overdue accounts (contacting clients to make sure Versant Health is receiving files in a timely manner and follow-up with clients to ensure files have been send and processed).
- Monitor Open Enrollment files (mid-year and end of year) to ensure that are OE files are accounted for and work closely with the Network Operations Center (NOC) to ensure all files are processed with “Special” criteria. Contact clients to monitor milestones.
- Support team activities and customer/position needs in the absence of a team member to ensure timely attention is given to all items.
- Turn over “Production” jobs to NOC Department
- Handle and respond to incoming department e-mail.
- Monitor daily NOC file processing in accordance with the defined Turn Over requirements and report to management weekly.
What’s necessary to do the job?
- Three (3) years of related experience
- Three (3) years of related work experience with Electronic Data Interchange (EDI), Enrollment/Eligibility file mapping, or programming preferred
- Direct client interface experience required; ability to read and interpret eligibility file layouts required
- Experience with inbound electronic enrollment files (e.g.) 5010 HIPAA 834 Enrollment Files preferred
- Preferred PC knowledge to include the following software applications: Microsoft Word, Microsoft Excel, Ultra editor, and Microsoft Access, EDI Gateways/Mapping Software
- Insurance experience helpful
HIPAA & Security Requirements
All Associates must comply with the Health Insurance Portability Accountability Act of 1996 (HIPAA) as it pertains to disclosures of protected health information (PHI) as described in the Notice of Privacy Practices and HIPAA Privacy Policies and Procedures. As a component of job roles and responsibilities, Associates may have access to covered information, cardholder data or other confidential customer information which must be always protected. As a result, Associates must explicitly adhere to all data security guidelines established within the Company’s Privacy & Security Training Program.
Versant Health will never request money from candidates who seek employment with us and will never ask for any payment as part of the recruitment process.
Versant Health is a proud Equal Employment Opportunity and Affirmative Action employer dedicated to attracting, retaining, and developing a diverse and inclusive workforce. All qualified applicants will receive consideration for employment at Versant Health without regards to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity or expression, age, disability, national origin, marital or domestic/civil partnership status, genetic information, citizenship status, uniformed service member or veteran status, or any other characteristic protected by law.
