Jobs at Evry Health

Own end-to-end enrollment data lifecycle: process and validate HIPAA 834/X12 files, perform data quality audits, enter and maintain member records, run SQL queries for cleanup, collaborate with engineering and operations to remediate data issues and support compliance reporting (ACA/CMS).

Lead development and management of geographic provider networks: negotiate and amend provider contracts, monitor network adequacy and quality, maintain rosters and contract records (Salesforce), coordinate credentialing, run compliance reports, analyze fee schedules with analytics/actuarial teams, and report network status, risks, and opportunities to leadership.

Manage provider disputes end-to-end in a commercial health plan: intake, investigate claim histories and contracts, apply coding and regulatory knowledge, process claim adjustments, draft provider correspondence, track case inventories in case management systems, analyze trends and recommend process improvements, and ensure regulatory compliance and audit readiness.