Sr. EDI Solutions Analyst

About the Role

Key Responsibilities

• Monitor Daily EDI Transaction Processing
• Troubleshoot and resolve any EDI processing issues
• Implementation Team Resource for EDI Mapping, Validation and Testing as required
• Prepare and update program documentation, job aids, and other artifacts as requested
• Scheduled and ad hoc auditing of various systems and databases to support prior authorization transactions
• Process review, data analysis and measurement for various programs related to prior authorizations, claims and member eligibility
• Create process and data flow diagrams for the various programs/projects as assigned
• Preparation of reports as needed by management
• Identification and communication of processing issues to leadership
• Prepares and coordinates presentations, training, etc.; used as an educational resource
• Implementation of innovative technologies and processes (including testing and follow-up)
• May involve some interfacing with clients, managed care customers, IT resources and others when needed
• Assignment of special projects as needed

Requirements

• 5+ Years of Experience in each of the following: experience within the healthcare data environment - eligibility, provider, claims, etc.
• Experience with data mapping and workflow documentation
• Healthcare EDI Transaction Knowledge and Expertise
• Specific EDI X12 ANSI 278 Transaction Expertise
• EDI transaction mapping experience
• EDI Production Support and Maintenance Experience
• EDI testing and validation experience
• Healthcare IT MMS (Medical Management Systems) experience
• Experience with SQL (manipulating data and queries) - Relational databases like MySQL, MS SQL, DB2
• Experience using Microsoft Word, Outlook, Excel (pivot tables, formulas like vlookup, xlookup, match), and Microsoft Visio

Nice to Have

• Ability to write clear technical and functional specs for authorization data integration services
• Experience building both EDI 278 real-time and batch mode integration services
• Experience with ETL (Extract Transfer Load) File Management and Archive Processes
• Experience working with cloud-based solutions and services
• Knowledgeable about claims billing practices and process management concepts - including CPT coding, reimbursement processes, third party provider enrollments, claims submissions, EDI and HIPAA transactions, and/or accounts receivables

Qualifications

• Experience within the healthcare data environment - eligibility, provider, claims, etc.
• Experience with data mapping and workflow documentation
• Healthcare EDI Transaction Knowledge and Expertise
• Specific EDI X12 ANSI 278 Transaction Expertise
• EDI transaction mapping experience
• EDI Production Support and Maintenance Experience
• EDI testing and validation experience
• Healthcare IT MMS (Medical Management Systems) experience
• Experience with SQL (relational databases like MySQL, MS SQL, DB2)

Benefits & Perks

• Competitive salary range of $89,800 to $176,700 annually based on full-time employment
• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase and 401k contribution
• Various other benefits subject to eligibility