Analyst I - Eligibility & Payment Services

What you can expect! 

Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!

Under the general director of the Manager, Business Systems Operations Support, the Analyst I - Eligibility & Payment Services Identify, research & reconcile billing payments to ensure accurate payments, eligibility determination, revenue & membership records for the Covered CA line of business. This position will verify, set up & maintain member data including but not limited to processing enrollments, corrections, retroactivity adjustments & terminations. The incumbent will outreach to members to advise on payment delinquency and resolution options.

Key Responsibilities

1. Maintain a comprehensive understanding of the system features and capabilities to provide effective support to Team and members. Navigate enrollment, eligibility, payment/billing, and other backend systems.
2. Act as a subject matter expert for Eligibility and Member Premium to help drive decisions related to system expectations, User Acceptance Testing (UAT) and provide detailed reporting requirements for Covered CA.
3. Implement business requirements to facilitate 3rd party system changes and develop non-systematic solutions when necessary.
4. Efficiently manage member-related tasks, including resolving Enrollment and Eligibility issues, conducting invoice validations, invalid balance research, and reviewing Premium billing correspondence.
5. Ensure Premium invoices, delinquency and reminder notices are accurate & mailed timely.
6. Research, gather, compile, and analyze structured Eligibility and monthly Premium data to formulate conclusions and recommendations.
7. Manage a workload consisting of multiple projects and assignments.
8. Responsible for the reconciliation of Eligibility and Premium billing streams ensuring disenrollment policy and procedures are practiced and monitored for accuracy. 
9. Research and maintain accurate regulatory requirements interpretation.
10. Research Premium discrepancies and disputes.  Coordinate and outreach to state or federal agencies to resolve.
11. Research payment discrepancies & delinquencies.
12. Work with internal and external customers & vendors to resolve any issues related to payment service activities.
13. Respond to incoming communications including correspondence, inquiries from members, providers, internal IEHP departments, etc. regarding members account status. This includes timely response to grievances and other regulatory concerns.
14. Perform follow up and outreach calls to members with outstanding balances on accounts. 
15. Conduct telephonic calls for member resolution regarding payment or premium dispute status.
16. Any other duties as required ensuring Health Plan operations are successful.

Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

Perks

IEHP is not only committed to healing and inspiring the human spirit of our Members; we also aim to match our Team Members with the same energy by providing prime benefits and more.

• CalPERS retirement
• 457(b) option with a contribution match
• Generous paid time off- vacation, holidays, sick
• State of the art fitness center on-site
• Medical Insurance with Dental and Vision
• Paid life insurance for employees with additional options
• Short-term, and long-term disability options
• Pet care insurance
• Flexible Spending Account – Health Care/Childcare
• Wellness programs that promote a healthy work-life balance
• Career advancement opportunities and professional development
• Competitive salary with annual merit increase
• Team bonus opportunities

Education & Experience

• A minimum of four (4) years of relevant work experience is required for this position: two (2) years of general managed care experience plus two (2) years of healthcare eligibility research experience is required
• At least two (2) years of experience demonstrating excellent organizational, time management, facilitation, and negotiation skills required
• One (1) year Accounts Receivable (AR) experience preferred
• High School Diploma or GED required

Key Qualifications

• Bilingual in Spanish/English 
• Knowledge of the 834-file format system preferred
• Excellent critical thinking, root cause analysis, decision making and problem-solving skills as well as excellent written and verbal communication skills with the ability to communicate and present effectively in large forums to discuss complex information. 

The work location for this position is classified as "telecommute." Telecommute Team Members must be available and willing to work at an onsite IEHP location when requested or as needed.

Start your journey towards a thriving future with IEHP and apply TODAY!