ob Title: EDI Analyst
100% Remote
Specific Skillset Requirements: Candidate must have robust knowledge and experience with 834 enrollment files and Facets.
Expenses allowed: no
Equipment to be Provided
Job Summary: Provides support for the EDI Operations department by interfacing with internal and external customers including business analysts, software developers, project managers, trading partners, and software vendors. This role is responsible for managing a range of EDI transactions including enrollment, claims, financial, and eligibility transactions using ANSI X12 HIPAA compliant formats. Provides technical support for the implementation of EDI connections with external parties; responds to inquiries related to EDI transactions; conducts analysis of EDI transactions; and provides issue resolution when necessary. Handles multiple enhancement requests and projects.
Essential Functions:
Essential Functions
- Demonstrate knowledge of EDI standard formats and communicate complex data exchange concepts to internal and external parties. Interface professionally with various internal and external customers including Operations, Sales, Marketing, IS, and Trading Partners to understand and process work requests.
- Responsible for the implementation of electronic data interchange connections between Priority Health and external parties. Support ongoing implementations in post-production, including error identification/resolution, continuous improvement, and pro-active communication with the trading partners and providers to reduce/prevent errors.
- Verify and monitor EDI processes. Troubleshoot and resolve EDI related issues. Develop and maintain procedural documentation. Follow-up comprehensively with all stakeholders during issue remediation process to assure that delays are minimized and the process runs smoothly.
- Assist in defining application enhancements and upgrades.
- Perform application configuration, mapping, and monitoring of EDI transactions and processes.
- Support application testing effort by performing user acceptance testing (UAT) and assisting in defect resolution.
- Provide on-call support as necessary.
Qualifications
- Required Associate's Degree or equivalent
- Preferred Bachelor's Degree
- 2 years of relevant experience Analyzing EDI data to identify content and/or formatting issues Required
- 2 years of relevant experience Using SQL queries to retrieve and/or display data Required
- 2 years of relevant experience Reading/analyzing/formatting/translating EDI data Required
- 2 years of relevant experience Implementing EDI setup and mapping Required
- 2 years of relevant experience Experience in the healthcare industry Preferred
- 2 years of relevant experience Experience with Facets software or a similar healthcare enrollment/claims management software system Preferred