Analista en Transacciones Electronicas
Regular
Non-Exempt
GENERAL DESCRIPTION:
Responsible for managing all electronic eligibility transactions.
ESSENTIAL FUNCTIONS:
- Informs the groups responsible for transmitting electronic eligibility about the errors detected and guides how to correct them.
- Meets deadlines by uploading files submitted by groups that transmit electronic eligibility data.
- Responsible for confirming the receipt and processing of eligibility files while reporting any discrepancies.
- Complies with the performance guarantees related to electronic eligibility set by the group to avoid incurring penalties.
- Analyzes eligibility files sent by the systems both before uploading (without updates) and after uploading (with updates) to Power MHS. Promptly identifies and resolves any issues found in the eligibility files in coordination with the Information Systems Department and requests any necessary changes or corrections.
- Communicates with the Information Technology Department to resolve conflicts.
- Engages with local and U.S. clients to address error corrections.
- Conducts audits as requested by clients.
- Completes the reconciliation of 834 files to report discrepancies to the vendor, executes any necessary updates in the system based on vendor or client feedback, and maintains a log of this reconciliation, including findings and corrections made.
- Ensures that cards for these groups are printed.
- Maintains reports of electronic transactions.
- Documents and archives all information related to electronic transactions.
- Must comply fully and consistently with all company policies and procedures, with local and federal laws as well as with the regulations applicable to our Industry, to maintain appropriate business and employment practices.
- May carry out other duties and responsibilities as assigned, according to the requirements of education and experience contained in this document.
MINIMUM QUALIFICATIONS:
Education and Experience: Associate’s Degree or 6sity to sixty-four (60-64) college credits. At least one (1) year of experience in eligibility, electronic transactions, and group structures.
“Proven experience may be replaced by previously established requirements.”
Certifications / Licenses: N/A
Other: N/A
Languages:
Spanish – Basic (comprehensive, writing and verbal)
English – Basic (comprehensive, writing and verbal)
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