Eligibility Analyst Northwest Physicians Network is now offering qualified candidates an opportunity to join our team as an Eligibility Analyst. Our company values innovative problem solvers promotes personal and professional growth and provides a supportive working environment that affords all team members a healthy work/life balance. In support of NPN's mission, vision, and strategic goals, the Eligibility Analyst is responsible for analyzing data from disparate systems, to reconcile, monitor, and affect change on the membership/eligibility for Medicare, Medicaid, and Commercial lines of business. Serves as subject-matter expert and key contact for membership/eligibility issues, data, and reporting. Assumes the role of the lead position in the Eligibility department and provides direct support to the Finance Manager. Reconciles complex eligibility issues and processes. This position is required to effectively communicate with all the departments within the organization, as well as external areas (e.g., health plans, and contracted vendors). Northwest Physicians Network creates the opportunity for independent private practitioners to thrive in Washington State. By providing clinical integration support and data driven quality improvement, we have created a high value delivery network, making it possible for our providers to remain focused squarely on their patients. Status: Regular, Full-time, FLSA Non-exempt Base Rate (negotiable d.o.e.) + Competitive Benefits Primary responsibilities will include: + Consistently exhibits behavior and communication skills that demonstrate the organization's commitment to superior customer service, including quality, care and concern with every internal and external customer. + Assumes duties of Manager in his/her absence and reports outcomes as appropriate. + Answers routine questions from staff and triages other issues to the Manager when necessary. + Researches, analyzes and reconciles the discrepancies between health plan eligibility files and the internal system according to established department guidelines. Verifies that all enrollments contain the correct data elements (i.e., group numbers, plan and effective date) as reported by the health plan. + Researches and resolves discrepancies in the PCP assignment between the health plan eligibility files and the legacy system. Makes sure of accurate capitation payments from health plans. + Responsible for processing all eligibility files from health plans. + Obtains and input into the legacy system accurate fee-for-service eligibility and benefits information for non-HMO members including PPO, EPO, Medicare and POS product lines. + Participates in provider clean-up projects. + Follows through to resolution with health plan on unresolved eligibility issues. Refers to Supervisor when additional intervention is necessary. + Oversees data integrity of member/patient eligibility records and remittance files received from the health plan. + Responsible for internal eligibility file load process while reconciling discrepancies. + Researches eligibility issues that impact claims processing and maintains turnaround time to ensure claims payment compliance. + Researches errors by comparing eligibility error reports against system information along with the health plan records. + Searches internal systems, health plan websites and calls to health plan to confirm member eligibility status. + Initiates and assists with development/changes to increase or change the quality and productivity of eligibility file processing. + Responds to internal staff and health plan questions to verify members eligibility status. + Reconciles eligibility discrepancies, analyzes transactional data and submits retroactive eligibility changes. + Researches and analyzes information to make decisions on member/patient eligibility for clinical services and claims processing and update the appropriate system. + Uses, protects, and discloses patients' protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards. + Other duties as assigned related to this role. Knowledge, Skills, and Abilities: + Industry knowledge of the enrollment, membership, and capitation payment process of a health plan. + Experience with healthcare data systems, Microsoft Office Suite and SharePoint. + Strong Excel knowledge and experience. + Must work well in a team-centered culture. + Skill in gathering, interpreting and analyzing complex data and reports. + Skill in exercising initiative, judgement, problem solving, and decision-making. + Skill in developing and maintaining effective relationships with internal staff, network practices, clients, regulators, public, and all other associated stakeholders. + Knowledge of specific communication needs with the ability to listen actively and respond to internal and external customers in a timely, competent manner both verbally and in writing. + Ability to handle high levels of pressure and critical decision-making. + Ability to review and synthesize data and create dashboards and reports using data/information from multiple systems. + Ability to plan work independently. Minimum Requirements: Education: + Bachelor's Degree in business or other related field, or equivalent combination of education and experience. Experience: + Minimum of three years' experience in a health plan or membership/enrollment environment. Three years recent experience performing data analysis. Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Here you'll find incredible ideas in one incredible company and a singular opportunity to do your life's best work.(SM) Diversity creates a healthier atmosphere: Optum and its affiliated medical practices are Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. Optum and its affiliated medical practices is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.