Eligibility Analyst - Remote

- Oversee the quality of eligibility that drives claims adjudication - Ensure data integrity for upstream client eligibility shared with downstream vendors and systems - Manage testing, monitoring, issue resolution, and escalations - Analyze and address complex eligibility challenges affecting claims and member coverage - Assist in root cause analysis for recurring eligibility defects and discrepancies - Serve as a resource for escalation of Analyst I/II eligibility inquiries - Collaborate with EDI, Implementation, Adjudication, and QA teams for testing and support - Validate eligibility data across various systems and recognize cross-functional impacts - Review eligibility outputs for precision and compliance with standards - Update and improve eligibility documentation and processing standards - Maintain profiles on TPA/TPVs to align with Liviniti strategies - Support audits and internal evaluations of eligibility accuracy - Monitor production trends and identify risks or areas for enhancement - Ensure adherence to HIPAA, security protocols, and Liviniti standards - Work closely with clients, vendors, and stakeholders to implement new eligibility feeds and enhancements - Identify opportunities for automation and process enhancements within eligibility workflows - Report any HIPAA violations to the Compliance Officer and/or Human Resources - Complete and demonstrate competency in all required HIPAA training offered by the company