Job Description :

Minimum Qualification:

  • A minimum of two (2) years of experience working with the federal or state-based health care systems. 
  • Proficiency using Microsoft Office Suite (MS Word and MS Excel).
  • Working knowledge of the basic database functionalities, EDI 834/999 structure, and Medicaid MA 8001 transactions.
  • Experience using Salesforce CRM (Or Other CRM)
  • Ability to analyze and interpret data and organize information into reports or presentations.
  • Excellent communication skills, problem-solving skills, knowledge retention skills, and listening abilities.
  • Demonstrated ability to understand system application functionality.

Preferred Qualifications:

  • Two or more years of experience in the healthcare industry.
  • Experience with data analysis, healthcare products, or system-related research.
  • Experience in Medicaid and Client Information Systems (CIS) and State-Based Marketplace systems.

Duties & Responsibilities:

  • Research into the 8001 Enrollment Transactions generated out of the HBX system for identifying any missing mandatory data.
  • Identify the best match for the Individual Registration Number (IRN) by accessing and analyzing data from multiple systems across MHBE, DHR, and DHMH.
  • Analyze and reconcile the HBX 8001 transactions with the MMIS application.
  • Analyze data errors and track 834 Benefit Enrollment and Maintenance records in the HBX system.
  • Utilize data matching and correction protocols to process escalated system errors to process high volumes of data reconciliation efforts on a daily basis.
  • Research into Member Level Record (MLR) data from the Carriers, obtain additional information from the consumers, analyze and resolve 834 escalated cases.
  • Research into MA 8001 data and EDI 834 data sent to the MCOs, EDI 999 error report received from the consumers, analyze and resolve 834 MA escalated cases.
  • Analyze and collate data from daily 8001, 834 error reports and Interim Database (IDB), to produce data reconciliation and escalation reports for the MHBE EDI, Call Center and Case Management teams.
  • Research 834 and 8001 escalated cases using CRM records, and update CRM records upon resolution.

Client : Maryland Health And Benefit Exchange


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