It's Time For A Change
Your Future Evolves Here
Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.
Are we growing? Absolutely about 40% in year-over-year revenue growth in 2018. Are we recognized? Definitely. We have been named one of "Becker's 150 Great Places to Work in Healthcare" in 2016, 2017, 2018 and 2019, and One of the "50 Great Places to Work" in 2017 by Washingtonian. We recognize employees that live our values, give back to our communities each year, and are champions for bringing our whole selves to work each day. If you're looking for a place where your work can be personally and professionally rewarding, don't just join a company with a mission. Join a mission with a company behind it.
What You'll Be Doing:
The Business Analyst, Enrollment Operations is responsible for finding ways to improve the accurate and expedient processing of all membership transactions of On-Exchange, Off-Exchange, and various Commercial lines of health benefit administration. This requires ongoing analysis and supervision of activities and deliverables that will improve enrollment operations. This includes but may not be limited to: new implementation support, file load processes, evaluation of existing business operations, reviewing compliance with all relevant regulatory agencies, monitoring achievement of operational service levels and other special projects. The Business Analyst will be called upon to assist management on projects and special assignments and is accountable for establishing and maintaining productive relationships with internal departments across Evolent Health.
Assist with new client implementation support to ensure timely, accurate delivery enrollment data, claim data entry, system set-up, cross-departmental communication, standard reports, and exception reporting.
Assist in analyzing department processes and identifying new operational processes and recommendations for improvement.
Develop, refine and implement effective policies and procedures, and subsequent training, to ensure all team members can perform properly.
Develop knowledge in ACA Exchange, Centers for Medicare & Medicaid Service, Self-Funded, and all other applicable regulatory agencies that govern the enrollment data both received via electronic data interface (EDI) and non-EDI.
Identify way to improve ongoing reconciliation of group and agency enrollment data; including proactively reporting and resolving discrepancies.
Developing and analyzing appropriate team performance metrics.
Promote the use of accepted best practices and innovative strategies.
Keep abreast of changes in requirements.
Assist the team in resolving administrative and routine operational issues as they arise
Other duties as assigned.
The Experience You'll Need (Required):
4-year college degree preferably with a quantitative major or equivalent work experience
SQL programming experience
Proficient in Microsoft Excel and Microsoft Word
Understanding of claim processing environment and knowledge of claim adjudication process/concepts.
Overall understanding of health care benefit administration, Third Party Administrator, or Pre-Tax Benefit environment.
Ability to communicate to other internal business teams during cross-functional projects and ability to implement conflict resolution strategies.
The interpersonal skills necessary include the ability to work well within a team that includes all levels within the organization as well as clients and brokers outside of the organization.
Understands and can work in a production environment in which performance is tied to operational metrics
Strong analytical ability necessary to work, discover and outline systems related issues independently as well as within a team.
The ability to take the lead on projects and recommend and implement process to complete work.
Finishing Touches (Preferred):
1-2 years of IT and/or business experience in an HMO/PPO Claims, Medicaid, Medicare and/or managed care healthcare environment
Understanding of X12 files, 834 files, paper enrollment, and billing/invoicing.
Superior root cause analysis skills, including corrective action planning and ability to provide documentation to support analysis.
Experience in process improvement that utilizes six sigma, kaizen, and/or other process improvement methodologies in a transactional environment or has experience in being involved in process improvement in general that tie into measurable results
Demonstrated breadth and depth of experience regarding data analysis/reconciliation
Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin.
Evolent Health, Inc.