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   Current UPMC employees must apply in HR Direct

Enrollment Services Analyst- WFH-PGH

Description

UPMC Health Plan has an exciting opportunity for a Enrollment Service Analyst in the Government Enrollment Department.  This is a full time position working Monday through Friday daylight hours.  This will be a work from home position, but must be in the Pittsburgh area.

The Enrollment Systems Analyst takes a leadership role in ensuring enrollment system data integrity, identifying and developing business requirements, initiating enhancement requests, and reporting and tracking system issues. Responsible for comprehensive, complex data analysis for Enrollment data using a variety of software and analytical tools. The Enrollment Systems Analyst provides technical expertise and performs the planning, development, testing, documentation and implementation of various system/program enhancements and updates to enrollment transactional systems. To successfully perform this role, the Enrollment Systems Analyst must have a comprehensive understanding of enrollment processing and reconciliation procedures, as well as enrollment regulations set forth by the Enrollment Services Manager, Centers for Medicare and Medicaid Services (CMS), Pennsylvania Department of Welfare (DPW), and/or Pennsylvania Insurance Department (PID). The Enrollment Systems Analyst acts a department liaison with various internal departments and vendors (as applicable) to communicate system processing issues or trends and identify opportunities for system enhancements. Ability to accurately and effectively marry the business requirements and needs with technical expertise to streamline processes and achieve regulatory compliance ongoing. Responsible for responding to internal customer inquiries and resolving issues to meet or exceed service requirements.

Responsibilities:

  • Perform statistical analyses, and then be able to explain this analysis to a non-technical audience of both internal and external customers and, at times, senior management.
  • Regularly analyzes existing system functionality to assure system functionality is compliant with state and/or federal regulations, as defined by CMS, DPW, and/or PID.
  • Tracks, trends, and provides reporting for system processing issues.
  • Conducts routine reconciliation of open system issues. Identifies compliance risks and escalates to management.
  • Manage and complete special projects as identified.
  • Develops and maintains reports as necessary; meeting established content criteria and deadlines for turnaround time.
  • Provide regular updates and final summaries for special projects completed.
  • Creates and maintains relevant databases as needed.
  • Ongoing education of regulations in relation to enrollment/disenrollment processing.
  • Reviews newly released guidance to analyze impact on system processing, identifying and making recommendations for necessary system functionality updates to ensure ongoing compliance.
  • Provide technical expertise for and perform the planning, development, testing, documentation and implementation of various system/program enhancements and updates.
  • Maintain employee/insured confidentiality.
  • Create, coordinate, and execute test plans for focused and integrated testing of system enhancements.
  • Access, investigate, and resolve issues to ensure customer satisfaction. Identify areas of concern that may compromise client satisfaction.
  • Coordinates team testing efforts.
  • Facilitate meetings with internal/external staff and external vendors to accomplish implementation of corporate initiatives, as necessary.
  • Meet deadlines and turnaround times set by Enrollment management (these deadlines and turnaround times will, at times, require the employee to work until the project is completed, meaning extended daily work hours, extended work weeks, or both).

 

Qualifications

  • High school graduate, college degree preferred.
  • 2-5 years of experience in health care insurance or health care industry required.
  • Ability to interpret and apply complex eligibility regulations as mandated by CMS, DPW, and PID.
  • Working knowledge of applicable lines of business (Commercial, Medical Assistance, Medicare, CHIP, and adult Basic) and associated products (HMO, PPO, EPO, PDP, Medicare Select, Medicare Supplement, National Complimentary Plan, and POS).
  • Person must demonstrate a high degree of professionalism, enthusiasm and initiative on a daily basis.
  • Ability to work in a fast-paced environment a must.
  • Will need to manage multiple tasks and projects, and forge strong interpersonal relationships within the department, with other departments, and with external audiences.
  • Attention to detail is critical to the success of this position, with skills in customer orientation and the ability to deal with ambiguity.
  • Excellent planning, communication, documentation, organizational, analytical, and problem solving abilities.
  • Advanced mathematical skills.
  • Ability to interpret and summarize results of various analyses in a timely and meaningful way.
  • Ability to effectively approach problem solving.
  • Ability to re-engineer processes to positively impact productivity in terms of timeliness and accuracy.
  • Ability to analyze financial & clinical results and to comprehend forecasting models.


Licensure, Certifications, and Clearances:

UPMC is an Equal Opportunity Employer/Disability/Veteran

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   Current UPMC employees must apply in HR Direct