evry-health - Enrollment Data Analyst
Requirements
• 2+ years of experience in health plan enrollment operations, managed care, or EDI data processing • Hands-on experience with HIPAA 834 transaction processing and X12 EDI standards • Proficiency with SQL-- able to write queries to retrieve, validate, and correct enrollment data directly against relational databases • Experience working within claims administration systems (e.g., Plexis QC, QNXT, TriZetto, HealthEdge, or similar). • Strong attention to detail with a proven ability to manage high volumes of data accurately • Familiarity with ACA eligibility and enrollment rules, CMS guidelines, and HIPAA data privacy • Experience with web-based enrollment portals or member engagement UIs • Understanding of downstream impacts of enrollment data on claims adjudication and provider rosters • Exposure to EDI mapping tools or translation software (e.g., Edifects, BizTalk, or Claritev). • Familiarity with population health platforms or care management systems • Experience supporting IRS Form 1095 or CMS risk adjustment data submissions • ## Tools & Systems • EDI / Enrollment Exchange • 834 X12 5010, trading partner portals, Claritev • Enrollment Web UI • Internal member management portal • Health plan claims adjudication platform • SQL Server (direct query access) • Office Productivity • Excel, SharePoint, ticketing systems • ## Competencies • Data Accuracy— Treats data integrity as mission critical; catches errors before they propagate • Problem Solving— Traces enrollment issues to root cause across EDI, UI, and database layers • Communication— Translates technical data issues into clear, actionable summaries for non-technical stakeholders • Urgency & Organization— Manages competing priorities, meets SLAs for enrollment processing windows • Collaboration— Works fluidly across operations, engineering, and compliance teams • ## Work Environment • This is a fully remote position. Candidates must reside in the United States within the Central (CST) or Eastern (EST) time zone. • Standard business hours are Monday through Friday, 9:00 AM – 5:00 PM CST, with occasional flexibility required to meet regulatory response deadlines. • Must maintain a dedicated, private workspace that is separate from other living areas and supports the secure handling of confidential information. • Must have a reliable high-speed internet connection. • All company-sensitive documents must be kept secure and handled in accordance with Evry Health data privacy and security policies.
Responsibilities
• 834 EDI Exchange & Enrollment Processing • Configure, monitor, and troubleshoot inbound and outbound HIPAA 834 (Benefit Enrollment and Maintenance) transaction files with trading partners, employers, and TPAs • Validate 834 file structures for compliance with X12 5010 standards, identifying and resolving segment errors, loop discrepancies, and rejected transactions • Coordinate with trading partners to resolve enrollment exchange issues and ensure timely, accurate file transmission • Data Validation & Quality Assurance • Perform systematic validation of member enrollment records against source documents, 834 transactions, and plan eligibility rules • Identify data anomalies, duplicate records, coverage gaps, and demographic inconsistencies • Execute data quality audits on a scheduled and ad-hoc basis, documenting findings and remediation steps • Ensure enrollment data aligns with plan effective dates, benefit periods, and group contract terms • Data Entry & Maintenance • Accurately enter and update member demographic, eligibility, and coverage data across the web UI enrollment portal and the claims processing system • Process member adds, terminations, changes, and reinstatements in a timely manner in compliance with CMS and ACA guidelines • Maintain supporting documentation for all manual data changes per audit and compliance standards • Data Cleanup & Remediation • Lead targeted data cleanup projects to address backlogs, legacy migration issues, and discrepancies identified through audits or operational escalations • Write and execute SQL queries against enrollment and member databases to identify, extract, and correct data issues • Collaborate with the engineering team on bulk update scripts and data remediation workflows • Cross-Functional Collaboration • Partner with engineering, claims, and population health teams to surface enrollment data issues affecting downstream claim adjudication, reporting, and care management workflows • Support compliance and reporting requirements including ACA 1095-B and CMS enrollment submissions • Communicate enrollment discrepancies and resolution status to internal stakeholders and external partners
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