Senior Operations Eligibility Analyst

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Job description

Senior Operations Eligibility Analyst (Remote) Role and Responsibilities

The Senior Operations Eligibility Analyst is responsible for overseeing and coordinating the processing of eligibility files between Liviniti's internal systems and external partners, including clients, vendors, and brokers. This role requires a deep understanding of eligibility file formats, systems integration, and troubleshooting issues related to data exchanges. The analyst will ensure that eligibility files are processed accurately and timely, while continuously improving processes to enhance operational efficiency. The Senior Operations Eligibility Analyst is expected to perform these and additional duties and responsibilities professionally and efficiently, contributing to the overall success of Liviniti:

• Manage the end-to-end process of eligibility file transfers between Liviniti and external partners.
• Collaborate with cross-functional teams to ensure seamless integration and data mapping of eligibility files.
• Analyze and resolve eligibility file-related discrepancies, errors, and data integrity issues.
• Maintain strong relationships with external vendors, clients, and partners to ensure timely and accurate data exchange.
• Develop and document eligibility file specifications, transmission protocols, and data requirements.
• Coordinate with internal teams to configure eligibility feeds for new and existing vendors.
• Lead eligibility file testing, validation, and implementation with partners and internal teams.
• Ensure adherence to Liviniti's privacy and security standards regarding eligibility data.
• Maintain thorough knowledge of file types, including 834, fixed width, delimited, and proprietary formats, ensuring proper mapping, transformation, and integration.
• Monitor ongoing performance and proactively resolve issues related to eligibility file processing.
• Provide mentorship and guidance to junior team members or specialists, as necessary.
• Abides by all obligations under HIPAA related 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.
• Attends, completes, and demonstrates competency in all 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, obligations, and activities may change, or new ones may be assigned at any time with or without notice.

What We Have To Offer

• 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

• Exceptional organizational and multitasking skills.
• Strong analytical and problem-solving abilities.
• Ability to manage multiple priorities in a fast-paced, deadline-driven environment.
• Expertise in eligibility file formats, data mapping, and system integrations.
• Excellent communication skills, both written and verbal, to interact with external partners and internal teams.
• Proficiency in various file transmission protocols (FTP/Secure FTP, VPN) and tools such as MS Office.
• Ability to work independently while maintaining strong collaboration with cross-functional teams.
• Familiarity with HIPAA and other regulations about data privacy and security.
• Ability to adapt and thrive in a dynamic, growth-oriented company culture.

Supervisory Responsibility

There could be supervisory responsibilities in this role with Junior Analysts or Specialists reporting to this role.

Position Type and Expected Hours of Work

• Full-time/Salaried/Exempt.
• 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 West to the East Coast, work times must be adjusted to cover meetings in all time zones. Ability to work extended hours, weekends, and holidays pursuant to industry demands.

Travel

This position has minimal travel expectations.

Required Education and Experience

• Bachelor's degree in business, Information Systems, or a related field.
• Minimum of 3-5 years of experience in eligibility management, operations, or a similar field.
• Experience working with file formats such as 834, XML, or other eligibility data formats.
• Experience working with SQL
• Proven experience with data mapping and troubleshooting file transmission issues.
• Familiarity with data validation and transformation logic.
• Knowledge of PBM claims adjudication processes is a plus.
• Advanced proficiency in Excel, including the use of formulas and data validation tools.
• Experience in project management or process improvement is preferred.

Liviniti, LLC provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, 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 all 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 origin, age, genetic information, disability, or veteran status. Improper interference with the ability of Liviniti, LLC employees to perform their job duties may result in discipline up to and including discharge. EOE M/F/D/V

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