Billing and Enrollment Analyst
The Billing andEnrollment Analyst supports and optimizes enrollment, eligibility, billing, andmembership operations. This role analyzes complex enrollment and financialdata, oversees invoice and reconciliation processes, ensures regulatory and operationalcompliance, and partners with internal and external stakeholders to resolvemembership and billing issues.
About the Company
Antidote Health is a tech-driven health insurance company on a mission to make healthcare easy, accessible, and more affordable. We’re rethinking how healthcare works—using technology to remove the friction, complexity, and delays that define the traditional system. Instead of navigating paperwork, long waits, and disconnected experiences, we’re building a simpler, more connected way for people to get care.
Our platform combines health coverage, virtual care, and a modern member experience into one seamless system designed to help people actually use their benefits.
We offer Affordable Care Act (ACA) health plans in Arizona and Ohio, and we’re growing quickly. We’re building a company focused on solving real problems—with real impact on people’s lives.
Position Overview
The Billing andEnrollment Analyst supports and optimizes enrollment, eligibility, billing, andmembership operations. This role analyzes complex enrollment and financialdata, oversees invoice and reconciliation processes, ensures regulatory and operationalcompliance, and partners with internal and external stakeholders to resolvemembership and billing issues. The position also supports rapid organizationalgrowth by helping implement new markets, products, systems, and scalableprocesses while advancing automation and operational efficiency.
This opportunity is open to remote, but our preference remains hybrid in NYC.
Key Responsibilities
Enrollment and Eligibility Operations
- Analyze enrollment and eligibility transactions to ensure accurate member maintenance and compliance with federal, state, regulatory, and organizational requirements.
- Review enrollment files, reports, and data exchanges to identify processing errors, discrepancies, trends, and operational risks.
- Validate member enrollment records, research complex enrollment issues, and coordinate timely resolution to ensure accurate member outcomes.
- Perform audits and quality assurance reviews to maintain data integrity, transaction accuracy, and operational compliance.
- Collaborate with internal departments and external partners to resolve enrollment discrepancies and improve end-to-end processes.
- Support rapid growth and expansion initiatives, including new market implementations, product launches, system conversions, and operational scaling.
- Lead or participate in implementation projects by analyzing requirements, coordinating testing, validating data, documenting outcomes, and supporting production readiness.
- Design and implement scalable enrollment processes that support increasing membership, business expansion, and evolving regulatory requirements.
Billing and Membership Operations
- Review, validate, and generate member and group invoices to ensure accuracy, completeness, timeliness, and compliance with billing requirements.
- Investigate and resolve billing disputes, premium discrepancies, and payment-related issues in collaboration with internal teams and external stakeholders.
- Perform premium, payment, membership, and account reconciliations to identify, research, document, and resolve variances.
- Analyze enrollment, billing, and financial data to support operational decision-making, identify trends, and recommend process improvements.
- Research and resolve complex account and billing issues while maintaining detailed documentation of findings, actions, and resolutions.
- Monitor invoices, premium payments, adjustments, refunds, financial transactions, and billing outputs to ensure data integrity across enrollment and billing systems.
- Partner with Finance, Customer Service, Operations, Compliance, and Technology teams to support accurate billing and payment processing.
- Support month-end and year-end reconciliation activities, financial reviews, and internal or external audits.
- Serve as a subject matter expert for billing, premium collection, reconciliation, and membership-related processes.
Data Analysis, Automation, and Reporting
- Analyze large and complex data sets containing enrollment, eligibility, billing, payment, membership, and financial information to identify trends, anomalies, risks, variances, and improvement opportunities.
- Develop, maintain, and distribute operational reports, dashboards, reconciliations, and performance metrics.
- Investigate root causes of data variances and recommend sustainable corrective and preventive actions.
- Monitor key performance indicators and provide clear, actionable insights to leadership and operational partners.
- Identify opportunities for process automation and workflow optimization that reduce manual effort, increase accuracy, strengthen controls, and improve scalability.
- Partner with business and technology teams to develop automated reporting, SQL-based data queries, data validation, reconciliation, and workflow solutions.
- Evaluate existing processes and recommend technology-enabled improvements that enhance productivity and operational effectiveness.
Compliance and Quality Assurance
- Ensure enrollment and billing activities comply with applicable CMS, federal, state, health plan, and organizational requirements.
- Support internal and external audits by providing accurate documentation, analysis, evidence, and issue resolution.
- Maintain complete and accurate records for operational processes, investigations, reconciliations, and audit requests.
- Participate in continuous improvement initiatives that increase efficiency, strengthen controls, and reduce operational and financial risk.
- Develop and maintain standard operating procedures, process maps, training materials, and implementation documentation.
Qualifications
Required
- Bachelor's degree in Business Administration, Healthcare Administration, Finance, Accounting, Information Systems, or a related field, or an equivalent combination of education and experience.
- Experience with QNXT enrollment, billing, and core administration platform.
- Minimum of five years of experience in health insurance billing, enrollment, eligibility, membership operations, or related healthcare administration functions.
- Experience with ACA, Medicare, Medicaid, commercial health plan, or other regulated enrollment and billing processes.
- Experience analyzing operational, enrollment, billing, and financial data in a healthcare or insurance environment.
- Demonstrated experience supporting rapid organizational growth through operational scaling, system implementation, process redesign, or business transformation.
- Experience participating in or leading billing, enrollment, eligibility, or technology implementations from requirements gathering through production deployment.
- Experience with invoice generation, billing review, account reconciliation, payment research, and dispute resolution.
- Strong analytical and problem-solving skills with the ability to interpret complex enrollment, billing, and financial data.
- Proven ability to analyze large data sets, identify discrepancies, recognize patterns, investigate root causes, and translate findings into actionable operational and financial recommendations.
- Advanced attention to detail and accuracy when reviewing financial transactions, enrollment records, premium activity, and account data.
- Advanced proficiency with Microsoft Excel, SQL, and reporting tools, including querying and analyzing large data sets, data validation, reconciliations, pivot tables, complex formulas, lookups, and financial analysis.
- Proven ability to identify automation opportunities and implement process improvements that increase efficiency, scalability, and accuracy.
- Working knowledge of process mapping, workflow optimization, testing, implementation readiness, and continuous improvement practices.
- Excellent written and verbal communication skills, with the ability to present findings to technical, operational, and leadership audiences.
- Demonstrated ability to manage competing priorities and meet deadlines in a fast-paced, high-growth environment.
- Ability to work independently, exercise sound judgment, and collaborate effectively across departments and organizational levels.
Preferred
- Knowledge of CMS enrollment transactions, 834 EDI processing, reconciliation activities, and health insurance billing operations.
- Experience supporting health plan implementations, system migrations, new product launches, or large-scale operational transformations.
- Experience with SQL, relational databases, business intelligence, reporting, workflow automation, robotic process automation, or data visualization tools.
- Lean, Six Sigma, project management, business analysis, or process improvement experience.
- Experience supporting audits, regulatory reporting, and operational compliance initiatives.
Compensation and Benefits
- Base salary range: $80,000-90,000 (commensurate with experience and location)
- Eligible for equity
- Comprehensive benefits package including medical, dental, vision
- 401(k)
- Paid vacation and sick time and company holidays
Company Standards and Expectations
- Employment is at-will, meaning either the employee or the company may terminate employment at any time, with or without cause, in accordance with applicable law
- Employees are expected to adhere to all company policies, including confidentiality, data protection, and code of conduct
- Responsibilities may evolve based on business needs, and flexibility is expected as the company scales
- Compliance with all applicable federal, state, and local laws and regulations is required
Equal Opportunity Statement
Antidote Health is an equal opportunity employer and makes employment decisions without regard to race, color, religion, sex, national origin, age, disability, veteran status, or any other protected status under applicable law.
