Business Analyst- Eligibility and Enrollment
Evolent Health
 Arlington, VA

It’s Time For A Change…Your Future Evolves Here

Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.

Are we growing? Absolutely—56.7% in year-over-year revenue growth in 2016. Are we recognized? Definitely. We have been named one of “Becker’s 150 Great Places to Work in Healthcare” in 2016 and 2017, and one of the “50 Great Places to Work” in 2017 by Washingtonian, and our CEO was number one on Glassdoor’s 2015 Highest-Rated CEOs for Small and Medium Companies. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.

Optional: Who You’ll Be Working With:

We are looking for bright and energetic individuals to join our Business Integration (BI) team developing business processes, designing and building on requirements for new and existing clients implementations, business process support with emphasis on end to end provider data management business and technical processes.

What You’ll Be Doing:

  • Define business requirements and acceptance criteria/test cases that support member eligibility and enrollment data analysis including billing and invoicing activities.
  • Define and develop process driven flows that support mailroom activities.
  • Participate in brain storming sessions to develop new concepts to build efficiencies in processing, mailroom functions.
  • Research, interpret and summarize new Medicare Advantage and client rules regarding department functions.  Alter or create policies and procedures to adhere to those rules.
  • Define business requirements and acceptance criteria/test cases related to Medicare Advantage plans for enrollment and eligibility.
  • Utilize a variety of software and platforms for statistical analysis and research concerning data
  • Create and standardize solutions and workflows.
  • Perform business analysis of identified process and software gaps or inefficiencies and develop plans to fill those gaps for internal business processes and for external clients.
  • Perform requirements review with external and internal stakeholders and obtain sign off from all required individuals.
  • Provide training to staff on new enhancements
  • Research, interpret and summarize Medicare Advantage and client rules regarding department functions.  Alter or create policies and procedures to adhere to those rules.
  • Identifies and documents system deficiencies and recommends solutions.
  • Ensures continuing operational quality by documenting fixes and enhancements.
  • Participates in the management of the sequencing of releases to meet business needs for enhancements, automations and implementations.
  • Identifies and documents system deficiencies and recommends solutions.


The Experience You’ll Need (Required):

  • Extensive knowledge in health insurance third party administrator concepts for Medicaid, Medicare Advantage or Commercial plans specifically support operational processes for enrollment and eligibility functions.
  • Knowledge of CMS regulations to determine enrollment functions.
  • Knowledge of enrollment extracts sent to CMS to reflect data integrity regarding Medicare Advantage programs.
  • Knowledge of health insurance, HMO, PPO, DSNIP and managed care principles including Medicaid and Medicare Advantage regulations.
  • Knowledge of Member Portal functions.
  • Knowledge of member matching rules while loading the eligibility data in the system.
  • Knowledge of interpreting key elements (COB, Group Plans, member information, PCP) on the eligibility files received from CMS.
  • Solid communication skills with working session facilitation.
  • Strong time management and organizational skills.
  • Excellent interpersonal, oral and written communication skills.
  • Strong attention to detail and organization.
  • Strong analytic skills.
  • Able to work independently and within a collaborative team environment with little guidance/supervision.
  • 2+ years of computer skills, especially: Word, Excel, Visio, Power Point, ticketing systems and SharePoint.
  • 3+ years of experience leading projects and cross functional teams in an automated production environment.
  • Ability to successfully balance deadlines, projects, and day to day responsibilities.


Finishing Touches (Preferred):

  • Associate or Bachelor’s degree preferred.
  • Certified Business Analyst is strongly preferred; equivalent demonstrated business analysis experience.
  • Extensive experience with the System Design Life Cycle (SDLC).
  • Superior root cause analysis skills, including corrective action planning and ability to provide documentation to support analysis.


Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin.