Managed Care Analyst I

About the role

We’re a collaborative, patient-focused organization dedicated to excellence in managed care and provider support. In this role, you’ll have the opportunity to grow your analytical expertise, contribute to cross-functional process improvements, and be part of a team that values precision, integrity, and teamwork.

Responsibilities

• Maintain eligibility files using multiple electronic platforms including Eddie, Bowman, and EZ-Net.
• Research and resolve eligibility issues for UM/QM and Claims Departments.
• Reconcile Eligibility and Capitation reports to ensure data accuracy.
• Update misassigned and unassigned member information to ensure accurate PCP capitation.
• Communicate with health plans and employer groups to verify and update eligibility information.
• Download and review reports from health plans for eligibility verification.
• Aid in identifying benefit plan codes and verifying benefits, including the input of copays, coinsurance, and deductibles.
• Research and resolve requests from the Finance Department regarding PCP assignment changes, terminations, or additions.
• Act as a liaison for PCPs, specialists, and clients to verify eligibility and document resolutions.
• Provide claim details to health plans for Workers’ Compensation requests.
• Research eligibility for Revenue Recovery inquiries and projects.

Qualifications

• High School Diploma required; Bachelor’s Degree desirable or equivalent combination of education and experience.
• Minimum of three (3) years of healthcare experience and/or training required.
• Familiarity with EZ-Cap and Microsoft Office Suite (Excel, Outlook, Word); ability to learn new systems quickly.
• Strong analytical and problem-solving skills with high attention to detail.
• Excellent oral and written communication skills; able to communicate professionally with all levels of staff and external partners.
• Proven ability to manage multiple priorities and meet deadlines in a fast-paced environment.
• Demonstrated professionalism, diplomacy, and trustworthiness.
• Positive attitude and strong team player.
• Ability to negotiate, problem-solve, and make independent decisions as needed.

Benefits

Competitive benefits package that includes 401k matching, Paid Time Off, Medical, Dental, Vision, and supplemental options.