19 Apr
Sr. EDI Analyst
California, Ranchocordova , 95741 Ranchocordova USA

Vacancy expired!

Day to Day Responsibilities of this Position and Description of Project: Provides analysis and support to both internal and external customers on EDI-related issues (i.e., electronic exchange of data including enrollment, claims, payments, and clearinghouse activities). Responds to inquiries relating to EDI from providers, brokers, third party-administrators, and internal departments. Provides analysis, support and guidance to both internal and external customers on moderate to complex electronic data transfers covering enrollment, claims, billing statements and payments. Conducts routine data analysis, needs assessments, and cost/benefit analysis to align information technology solutions with business initiatives. Formulates and defines routine to complex systems scope and objectives through research combined with an understanding of applicable business & EDI systems and industry requirements. Develops or modify information systems. Includes analysis of business and user needs, defining requirements and revising existing systems. Identifies a desired future state that addresses a business problem utilizing multiple analytic methodologies and business process modeling. Conducts research, impact analysis and determine to complete requirements elicitation and defining the breakdown of tasks, resource loading, issue tracking and resolution management. Collaborate with IT to identify and develop future state to ensure the accurate development of solution meets business requirements. Designs and develops approaches that are implemented by others. Perform analysis to support quality and continued process improvement recommendations to improve EDI acceptance rates and improve straight through processing to reduce file errors. Determines needs and capabilities of high profile, complex external customers to submit data electronically. Conducts data transfer testing, scheduling, and reviews and approves transaction in accordance to industry/ company/legal/security standards. Data transfer scheduling, monitoring and quality assurance activities Track daily data transfers and production schedules. Ensures quality assurance and HIPAA standards are rigorously followed to ensure EDI transactions are compliant with industry, company, legal and security standards. Performs analysis and develop process improvement recommendations to improve EDI acceptance rates and improve straight through processing and reduce file errors. Lead and/or perform User Acceptance Testing (UAT) and production business validation testing. Prepares reports and statistics on electronic data transfer usage. Organizational Impact

  • Works to achieve operational targets with direct impact on departmental results.
  • Works independently under limited supervision.
  • Work is reviewed for adequacy in meeting objectives.
  • May be responsible for entire projects or processes within job area. Innovation & Complexity Problems and issues faced are difficult and may require understanding of broader set of issues. Problems typically involve consideration of multiple issues, job areas or specialties, and are typically solved through drawing from prior experience and analysis of issues. Develops new perspectives and approaches on existing problems. Communication
  • Communicates with parties within and outside of own department, with the ability to educate others on complex disciplines.
  • May have responsibility for communicating with parties' external to the organization (e.g., customers, vendors, etc.).
  • Works to influence parties within and outside of the job function at an operational level regarding policies, practices and procedures. Knowledge & Experience
  • A BA/BS in a related field such as business, management information systems, health care and/or equivalent combination of education and experience.
  • Strong knowledge of electronic data concepts and systems including business processes and system analysis.
  • Ability to independently develop and lead complex electronic data transfer implementation projects.
  • Detailed knowledge of health plan operations including enrollment systems and/or clearinghouse services.
  • Excellent interpersonal, team, customer service and communication (written and verbal) skills.
  • Strong attention to details.
  • Desired knowledge of health plan legal, brand, and regulatory compliance requirements.
  • Strong analytical and problem-solving skills.
  • Typically, requires advanced knowledge of job area typically obtained through advanced education combined with experience. May have practical knowledge of project management.
  • Typically, requires a college degree or equivalent experience and minimum 5 years of prior relevant experience.
  • Desired project management, business analysis (IIBA), or lean sigma certifications.
  • Strong analytical and problem-solving skills. Physical Requirements: Work from home office/deskwork - Activity level: Sedentary, frequency most of workday.

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