Research and Analyst (R & D)
ZDAAS won single contract at Maryland Healthcare and Benefits Exchange (MHBE) to provide research and analysis support services to reconcile the Enrollment Transactions (8001 transactions) between the Health Benefit Exchange (HBX) system and the Maryland Medicaid Management and Information Systems (MA-MMIS), and to resolve and track the 834 Benefit Enrollment and Maintenance records data with the Carriers and Managed Care Organizations (MCO).
ZDAAS will perform the following duties and responsibilities:
- Research into the 8001 Enrollment Transactions generated out of HBX system for identifying any missing mandatory data.
- Identify the best match for the Individual Registration Number (IRN) by accessing and analyzing data from multiple systems across MHBE, DHR and DHMH.
- Analyze and reconcile the HBX 8001 transactions with the MMIS application.
- Analyze data errors and track 834 Benefit Enrollment and Maintenance records in the HBX system.
- Utilize data matching and correction protocols to process escalated system errors to process high volumes of data reconciliation efforts on a daily basis.
- Research into Member Level Record (MLR) data from the Carriers, obtain additional information from the consumers, analyze and resolve 834 escalated cases.
- Research into MA 8001 data and EDI 834 data sent to the MCOs, EDI 999 error report received from the consumers, analyze and resolve 834 MA escalated cases.
- Analyze and collate data from daily 8001, 834 error reports and Interim Database (IDB), to produce data reconciliation and escalation reports for the MHBE EDI, Call Center and Case Management teams.
- Research 834 and 8001 escalated cases using CRM records, and update CRM records upon resolution.