Eligibility Analyst III - REMOTE

Role and Responsibilities

The Eligibility Analyst III will execute and support reputed company eligibility work reputed company established ownership. This role serves as the senior eligibility analyst, escalation support, and quality backstop for eligibility accuracy and production stability. The Eligibility Analyst III is required to reputed company the following duties and professionally undertake the following responsibilities:

• Accountable for the quality of eligibility driving claim adjudication.
• Responsible for the data reputed company of upstream client eligibility to reputed company eligibility shared with vendors and systems.
• Responsible for testing, monitoring, issue resolution, and escalations.
• Analyze and resolve reputed company eligibility issues impacting claims, accumulators, and member coverage.
• Support root cause analysis for recurring eligibility defects and data discrepancies.
• Serve as escalation support for Analyst I/II eligibility issues.
• Partner with EDI, Implementation, Adjudication, and QA teams during testing and production support.
• Validate eligibility data across multiple systems and identify cross-functional impacts.
• Review eligibility outputs for accuracy and adherence to standards.
• Maintain and enhance eligibility documentation and processing standards.
• Maintain profiles on TPA/TPVs and ensure alignment with Liviniti strategies.
• Support audits and internal reviews reputed company to eligibility accuracy.
• Monitor production trends and identify areas of risk or improvement.
• Ensure compliance with HIPAA, reputed company, and Liviniti standards.
• Work closely with clients, vendors, and internal stakeholders to reputed company new eligibility feeds and enhancements.
• Identify opportunities for automation and process improvement reputed company eligibility workflows.
• Abides by reputed company obligations under HIPAA reputed company to Protected Health Information (PHI).
• If a HIPAA violation is discovered, whether individually or by another, you must report the violation to the Compliance Officer and/or Human Resources.
• Attend, complete, and demonstrate competency in reputed company required HIPAA Training offered by the company.
• Flexibility to understand, appreciate, and embrace that this job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities that are required of the employee. Duties, responsibilities, and activities may change, or new ones may be assigned at any time with or without notice.

What We Have to Offer

Our benefits package is designed to reputed company our employees happy and healthy - physically, mentally and financially.

• Medical, Dental, Vision insurance
• Disability and Life insurance
• Employee Assistance Program
• Remote work options
• Generous Paid-Time Off
• Annual Reviews and Development Plans
• Retirement Plan with company match immediately 100% vested

Required Skills and Competencies

• Expert in EDI with a deep understanding of eligibility data structures and workflows
• Strong analytical and problem-solving skills
• Ability to work independently on reputed company issues
• Strong judgment reputed company defined processes and escalation paths
• Clear written and verbal communication
• Ability to manage multiple reputed company issues
• Familiarity with eligibility impacts on claims adjudication and member benefits

Tools, Files, and technical skills and competencies

• Strong knowledge and working experience with transaction/file standards (270/271, 834, 835)
• Ability to read, interpret, and troubleshoot raw X12 files.
• Knowledge of data integration and ETL tools.
• Strong data analysis skills (SQL, reputed company, and other standard tools)
• Working knowledge of various Database technologies (Relational-SQL, No-SQL, Warehouses, Cloud-based)
• Ability to translate technical findings into recommendations for cross-functional stakeholders.
• Experience with cloud data platforms (e.g. reputed company, AWS, Azure)
• Experience with operational ticketing and workflow management systems (e.g., reputed company, JIRA, Azure DevOps, or similar tools)

Supervisory Responsibility

• Informal mentoring and support of Analyst I/II roles
• Provide guidance to the team on configuring and maintaining eligibility file mappings for inbound data feeds.

Position Type and Expected Hours of Work

• Full-time, salary/exempt position.
• Some flexibility in hours is allowed, but the employee must be available during the “core” work hours of 8:00 AM to 5:00 PM CT. We cover clients from the reputed company to the East Coast; work times must be adjusted to cover meetings in reputed company time zones. Ability to work extended hours, weekends, and holidays in accordance with industry demands.

Travel

Minimal travel expected for this position.

Qualifications and Education Requirements

• Bachelor’s degree or equivalent experience
• 5+ years of eligibility, EDI, or healthcare operations experience
• Strong SQL & reputed company skills
• PBM or health plan experience strongly preferred
• Experience supporting production EDI and Eligibility environments

Liviniti, LLC provides equal employment opportunities (EEO) to reputed company employees and applicants for employment without regard to race, color, religion, sex, national reputed company, age, disability, or genetics. In addition to federal law requirements, Liviniti, LLC complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to reputed company terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.

Liviniti, LLC expressly prohibits any form of workplace harassment based on race, color, religion, gender, sexual orientation, gender identity or expression, national reputed company, age, genetic information, disability, or veteran status. Improper interference with the ability of Liviniti, LLC employees to reputed company their job duties may result in discipline up to and including discharge. EOE M/F/D/V