SlateRx

Compensation

Full Description

Company Bio: Founded by industry pioneers, SlateRx provides simple and affordable pharmacy benefit programs to employer groups, unions, public sector groups, health systems, and other payers throughout the United States. As the industry's only PBXTM, SlateRx is creating real value for plan sponsors on day one through purchasing scale and continued management via innovation and transparency. Our model is designed to improve an out-of-touch healthcare model to make pharmacy benefits simple and affordable for plan sponsors and members. Job Overview: As the Eligibility Analyst, you will play a pivotal role in shaping the eligibility and electronic data exchange (EDI) processes for our organization. Leveraging your expertise in _HIPAA X12 EDI transactions (834, 270/271, etc.), you work cross functionally with both internal and external stakeholders to enhance data quality, system performance and process automation. Responsibilities: As an Eligibility Analyst, your key responsibilities will include: • Process a variety of membership enrollment changes that require special handling while taking ownership and accountability through problem resolution. • Maintain an understanding of the electronic enrollment data flow processes between our employer groups, in order to complete complex transactions that may involve multiple systems, such as those needed to effect retroactive enrollment corrections). • Investigate transactions that did not go through the processing system by completing research within all available systems and/or consulting with the account manager and correcting errors within expected standards of performance for compliance and production. • Gain and maintain good familiarity with the plan designs and benefit setups for each client. • Respond to client / client designee emails, phone calls in a timely fashion. • Review correspondence and requests for investigation and/or action from clients, client designees, and/or other internal departments, investigate, respond to issues and take actions accordingly, or routes to proper area for completion. Maintain proper documentation for historical reference and audit purposes. • Research issues related to enrollment. • Execute SQL queries, extracting data from relational databases and tables for purposes of audit and reporting support. • Compile and provide daily, weekly and monthly enrollment and monitoring related reports both internally and externally. • Investigate and resolve errors in EDI file processing, transaction failures, and data mismatches. • Analyze EDI logs, audit trails, and error reports to diagnose root cause and implement corrective actions. • Provide technical support and guidance to internal teams and external partners regarding EDI eligibility workflows. • Work with developers and system analysts to troubleshoot system integration issues and enhance automation. • Maintain eligibility file processing security and adherence to dataprivacy policies. • Support internal and external audits related to EDI eligibility operations. • Partner with IT and Data teams to implement EDI process automation, system enhancements, and data validation rules. • Assist in testing and deploying system upgrades, new integrations, and business rule changes. • Other duties as assigned. Qualifications: To excel in this role, you should possess the following qualifications: • Minimum of 4+ years of experience in PBM eligibility management, data integration, or a similar field. • Experience working with PBM eligibility file formats such as 834, XML, and proprietary eligibility data formats. • Experience with data mapping, transformation and validation logic along with systems integration. • Familiarity with PBM claims adjudication processes and healthcare data standards. • Experience working with EDI platforms and tools. • Knowledge of cloud-based EDI environments (AWS, Snowflake, etc.). • Experience with automated testing and monitoring tools for EDI transactions. • Advanced proficiency in Excel, including using macros, pivot tables, and complex formulas. • Certification in project management (e.g., PMP, Six Sigma) or process improvement is highly desirable. • Working knowledge of running established SQL queries and familiarity with the use of databases for advanced data querying, analysis, and troubleshooting eligibility data discrepancies. • Hands-on experience with file transmission protocols (e.g.,FTP/Secure FTP, VPN) and automation tools. • Detail oriented with a high degree of accuracy and follow through. • Self-starter with the ability to work independently and as part of a team. Education: • Bachelor's degree in business, Information Systems, Data Analytics, or a related field or equivalent combination of education and experience in Pharmacy Healthcare. License Requirement: Job Benefits: Health, Dental, Vision, Life, 401k, Paid Time Off. Location: Remote