Medicare EDI Analyst I
Medicare EDI Analyst I
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Job Description
At Collective Health were transforming how employers and their people engage with their health benefits by seamlessly integrating cutting-edge technology compassionate service and world-class user experience design.
Eligibility data powers the Collective Health platformdriving member experiences benefit accuracy and regulatory compliance. As a Medicare Eligibility Analyst I you will play a critical role in ensuring the integrity and accuracy of Medicare-specific eligibility data supporting seamless continuation of benefits and maintaining compliance with CMS guidelines and federal regulations. You will be a high-impact team member that manages the ingestion validation and maintenance of key Medicare eligibility files including the 270/271 CMS file TIN file and MSP file.
In this role you will support the technical configuration testing and operational maintenance of Medicare file exchanges investigate eligibility discrepancies and help uphold high-quality standards across eligibility processes. This is an ideal opportunity for someone looking to expand their knowledge in Medicare data operations and compliance while contributing to a mission-driven team focused on transforming healthcare.
What youll do:
- Monitor and manage the processing of Medicare eligibility files ensuring compliance with CMS rules and accurate ingestion transformation and delivery.
- Develop and maintain deep knowledge of Medicare-specific file formats workflows and continuation of benefits rules.
- Investigate and resolve eligibility issues related to Medicare records including discrepancies in the 270/271 CMS file TIN file and MSP file.
- Maintain compliance with federal Medicare regulations company policies and partner requirements.
- Collaborate closely with Product Engineering and Implementation teams to ensure accurate configuration and testing of Medicare-related file integrations.
- Manage tickets and support inquiries meeting SLAs while documenting resolutions for continuous process improvement.
- Identify opportunities for workflow improvements and scalability particularly related to the Medicare file lifecycle and regulatory updates.
- Contribute to internal documentation ensuring clarity and audit readiness for Medicare eligibility processes.
To be successful in this role youll need:
- Required:
- 3 years of experience in eligibility operations with direct involvement in Medicare data processing.
- Strong understanding of Medicare continuation of benefits CMS rules and regulations and compliance frameworks.
- Experience managing and troubleshooting Medicare eligibility files: 270/271 transactions TIN file MSP file.
- Proficiency in Microsoft Excel and Google Workspace.
- Working knowledge of EDI file configuration SFTP systems and healthcare data formats.
- Basic SQL or Python proficiency for querying and data analysis.
- Strong problem-solving skills attention to detail and the ability to resolve discrepancies in large datasets.
- Effective cross-functional collaboration and communication skills including with regulatory and technical stakeholders.
- Nice to Have:
- Background in benefits administration or working with HRIS/Ben Admin systems.
- Experience supporting CMS audits or similar compliance-related processes.
- Understanding of U.S. healthcare insurance models and the structure of Medicare Advantage or traditional Medicare plans.
Pay Transparency Statement
This is a hybrid position based out of our Lehi office with the expectation of being in office at least two weekdays per week. #LI-hybrid
The actual pay rate offered within the range will depend on factors including geographic location qualifications experience and internal equity. In addition to the hourly rate you will be eligible for stock options and benefits like health insurance 401k and paid time off. Learn more about our benefits athttps:// UT Pay Range
Why Join Us
- Mission-driven culture that values innovation collaboration and a commitment to excellence in healthcare
- Impactful projects that shape the future of our organization
- Opportunities for professional development through internal mobility opportunities mentorship programs and courses tailored to your interests
- Flexible work arrangements and a supportive work-life balance
We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race religion color national origin gender sexual orientation age marital status veteran status or disability status. Collective Health is committed to providing support to candidates who require reasonable accommodation during the interview process. If you need assistance please contact .
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IC
Employment Type
Full Time
