EDI Analyst / Job Req 772072642 (Finance)
PRINCIPAL RESPONSIBILITIES:
The EDI Analyst will support the team by providing daily technical support for EDI activities, research questions and issue resolution; maintaining implementation companion guides; supporting the development of interfaces; performing data audits to validate information exchanged with the providers; and running reports as needed. The EDI Analyst will facilitate the process of onboarding providers for EDI claims submissions, assisting them with application paperwork, helping them work through testing, answering questions regarding the Alameda Alliance for Health companion guides, and approving providers for claims submissions after successful test cycles have been completed.
ESSENTIAL FUNCTIONS OF THE JOB:
Organization expects job performance to be consistent with its vision and mission. Day to day work is focused on these key performance areas. Percentages of time are estimates based upon observation in the position.
Develop and maintain trading partner definitions, and handling communications with trading partners for EDI transaction set-up, ongoing maintenance, proactively identifying issues and resolving them. (30% of time)
Automate and monitor the EDI transaction processes to ensure that transactions are processed accurately and on schedule, and appropriately follow up on any errors. Audits data to validate information supplied to/from providers/ and trading partners. (20% of time)
Responsible for EDI map development, testing, and maintaining EDI transactions. Also, participate in system analysis, design, development, and implementation of EDI activities. . (20% of time)
Work with internal teams and 3rd party partners to improve and scale our documentation of EDI processes (15% of time)
Participates in the analysis of existing business processes and systems recommendations/enhancements to improve business performance and maximize the effectiveness of available technology (15% of time). Other duties as assigned.
PHYSICAL REQUIREMENTS:
Constant and close visual work at desk or computer. Constant sitting and working at desk. Constant data entry using keyboard and/or mouse. Frequent use of telephone headset. Frequent verbal and written communication with staff and other business associates by telephone, correspondence, or in person. Frequent lifting of folders and other various objects weighing between 0 and 30 lbs. Frequent walking and standing.
Number of Employees Supervised: 0
MINIMUM QUALIFICATIONS:
EDUCATION OR TRAINING EQUIVALENT TO:
Bachelors Degree (technical, business or science degree preferred) plus minimum five years of work experience in managed health care (or equivalents
MINIMUM YEARS OF ADDITIONAL RELATED EXPERIENCE:
3 years of progressive experience with EDI, familiarity with .net and SQL
SPECIAL QUALIFICATIONS (SKILLS, ABILITIES, LICENSE):
Working, in-depth knowledge of ANSI ASC X12 and HIPAA standard formats, especially claims, enrollment, eligibility and claim status inquires, and remittances.
Knowledge of ANSI ASC X12 837 transaction set in version 5010.
Knowledge of medical billing or health care data and data interfaces.
Knowledge and skill set to automate the system to monitor/ report and notify EDI transactions.Professional verbal and written communication skills. Ability to effectively correspond with both business and technical staff and translate needs accordingly
PC based Microsoft Office Suite, SharePoint, and claim adjudication software interface experience.
HIPAA translation software and testing engines such as EDIFECS or ECS
SALARY RANGE: $110,094.40 - $165,131.20 ANNUALLY
The Alliance is an equal opportunity employer and makes employment decisions on the basis of qualifications and merit. We strive to have the best qualified person in every job. Our policy prohibits unlawful discrimination based on race, color, creed, gender, religion, veteran status, marital status, registered domestic partner status, age, national origin or ancestry, physical or mental disability, medical condition, genetic characteristic, sexual orientation, gender identity or expression, or any other consideration made unlawful by federal, state, or local laws. M/F/Vets/Disabled.
