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Enrollment Quality Auditor

HealthEdge
Remote, USA
Full-time
Mid · 3+ years experience
Remote
USD 44000-50000 yearly / year
Discovered 2 weeks ago
GuidingCareEDI 834

Full Job Posting

Geographic Responsibility

  • Remote, US
  • Type of Employment: Full-time, permanent
  • Work Environment: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job:
  • The employee is occasionally required to move around the office. Specific vision abilities required by this job include close vision, color vision, peripheral vision, depth perception, and ability to adjust focus.
  • Work across multiple time zones in a hybrid or remote work environment.
  • Long periods of time sitting and/or standing in front of a computer using video technology.
  • May require travel dependent on company needs.
  • The above statements are intended to describe the general nature and level of the job being performed by the individual(s) assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skills required . HealthEdge reserves the right to modify , add, or remove duties and to assign other duties as necessary. In addition, reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position in compliance with the Americans with Disabilities Act of 1990 . Candidates may be required to go through a pre-employment criminal background check.
  • HealthEdge is an equal opportunity employer. We are committed to workforce diversity and actively encourage all qualified persons to seek employment with us, including, but not limited to, racial and ethnic minorities, women, veterans and persons with disabilities.
  • #LI-Remote
  • ** The annual US base salary range for this position is $44,000 to $50,000 . This salary range may cover multiple career levels at HealthEdge. Final compensation will be determined during the interview process and is based on a combination of factors including, but not limited to, your skills, experience, qualifications and education.

Requirements

  • High School Diploma or GED required.
  • 3 years health plan enrollment/eligibility auditing operations experience required.
  • Medicaid managed care enrollment auditing experience preferred; managed long-term care (MLTC) or dual-eligible (Medicare-Medicaid) enrollment experience strongly preferred.
  • Proficiency in using MS Suite, specifically Excel, PowerPoint and Outlook.
  • HealthRules® Payor or GuidingCare® experience preferred; familiarity with EDI 834 enrollment transactions and eligibility verification systems a plus.
  • Ability to analyze contractual SLAs and KPIs, particularly around enrollment processing timeliness.
  • Ability to effectively communicate and collaborate with a remote team.

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