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 power that brings us to work each day. We believe in embracing new ideas, testing 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. We have seen about 30% average growth over the last three years. Are we recognized? Definitely. We were named one of “Becker’s 150 Great Places to Work in Healthcare” in 2016, 2017, 2018 and 2019 and are proud to be recognized as a leader in driving important Diversity and Inclusion (D&I) efforts: Evolent achieved a 95% score on its first-ever submission to the Human Rights Campaign's Corporate Equality Index; was named on the Best Companies for Women to Advance List 2020 by Parity.org; and we publish an annual Diversity and Inclusion Annual Report to share our progress on how we’re building an equitable workplace. 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:
- Partner with IT and business stakeholders as well as external trading partners to successfully implement a mix of initiatives ranging from functional enhancements and continuous improvements.
- Define business requirements and acceptance criteria/test cases related to programs facilitated by the Centers for Medicare and Medicaid (CMS)
- Review regulatory and policy changes from CMS programs, particularly the Federal Exchange and Medicare Advantage
- Act as a trading partner liaison with federal and state-based health insurance exchanges to foster communication between business/IT teams, developers and external stakeholders.
- Identify, document and analyze discrepancies and anomalies within automated data reconciliation and issuer dispute data
- Develop a deep understanding of the business rules, and leverage that knowledge to improve processes, recommend solutions, enhance team performance, and drive progression of client objectives
- Utilize a variety of software and platforms for statistical analysis and research concerning data
- Create and standardize solutions and workflows.
- Perform business analysis of identified process and software gaps or inefficiencies and develop plans to fill those gaps for internal business processes and for external clients.
- Perform requirements review with external and internal stakeholders and obtain sign off from all required individuals.
- Identify and document system deficiencies and recommends solutions.
The Experience You’ll Need (Required):
- Extensive knowledge in health insurance third party administrator concepts for commercial, federal and state government plans specifically supporting operational processes for enrollment and eligibility processing, member benefits, and EDI Interfaces
- Ability to read and understand SQL
- Experience with EDI X12 structure and syntax rules; chiefly with 834 files
- Knowledge of the Affordable Care Act, HMO and managed care principles including Medicaid and Medicare regulation.
- Solid aptitude of compiling data from many sources and defining designs for enrollment to benefit plan configuration.
- Strong analytical capabilities to understand data sets to derive business conclusions while identifying anomalies based on business rules
- Research, interpret and summarize new state, federal and client rules regarding department functions. Alter or create policies and procedures to adhere to those rules.
- Robust time management, attention to detail, analytic and organizational skills.
- Excellent interpersonal, oral and written communication skills.
- Able to work independently and within a collaborative team environment with little guidance/supervision.
Finishing Touches (Preferred):
- Associate or bachelor’s degree preferred.
- 3-5+ years of IT and/or business experience in an HMO/PPO Claims, Medicaid, Medicare and/or managed care healthcare environment
- Extensive experience with the System Design Life Cycle (SDLC).
- Superior root cause analysis skills, including corrective action planning and ability to provide documentation to support analysis.
- Demonstrated breadth and depth of experience regarding data analysis/reconciliation
Currently, Evolent employees work remotely temporarily due to COVID-19. As such, we require that all employees have the following technical capability at their home: High speed internet over 10 MBPS and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.
Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.