EDI Analyst - Encounters

EDI Specialists, Inc. in Albany County, NY

  • Industry: Information Technology - Others
  • Type: Full Time
position filled
Scope and Purpose of Position: The EDI Analyst is responsible for the support processes related and ensuring the timely and accurate processing of 837 X12 Encounters files for claims submitted by beneficiaries maintained in the healthcare claims system and other EDI related files. Major Duties and Responsibilities: Execution of reoccurring operational tasks in support of encounter data file generation; manage day-to-day production file monitoring including troubleshooting and error investigation and resolution. Validation of 837 encounter files using industry-standard HIPAA compliance rules via Optum Transaction Validation Manager (OTVM) and custom, in-house checks and edits. Interpretation of 999, 277, 835 and custom response files from states/clients based on encounter file submissions. Analysis of encounter/claim rejections based on state and client error reason codes; root cause analysis of underlying rejection driver in upstream systems and processes; implementation of corrective actions to remediate issues and minimize or eliminate future occurrences. SQL-based data analysis to identify trends in encounter rejections and correlations in claim, member and provider data. SQL-based report development and reoccurring report creation and delivery to clients adhering to pre-defined schedules. Providing ad-hoc data/reports to client or internal departments; responding to client inquiries. Coordination with external client and internal operational departments on new client implementations and changes for existing clients. Design and execution of EDI test plans; provide timely communication amongst clients. Participation in regular client update calls, providing status on open items. Configuration and maintenance of core systems and integrated processes for new customer implementations and change requests from existing customers. Produce comprehensive documentation of all processes and procedures. Automation of routine processes with appropriate monitoring controls. Other duties as assigned. Education: Bachelor's degree in Computer Science or related field or commensurate experience in EDI / data analyst role. Experience: 3 years' relevant work experience in health care industry 3 years' prior experience in a data analyst role, preferably within healthcare EDI. 3 years' SQL experience required Knowledge of HIPAA X12 file standards, especially the 837 claim/encounter specification is extremely desirable. Communication and coordination skills: Ability to lead data analysis efforts and client meetings is desirable. Ability to provide critical analysis on client needs as well as attention to details and accurately documenting processes. Experience in implementation of control and reconciliation reports. Knowledge and understanding of relational database environments. Team oriented with the ability to work effectively across functional areas of the company. Excellent analytical, problem resolution and people skills. Ability to deliver quality results under tight deadlines. Ability to work independently with moderate supervision. Understanding of vision care insurance data is a plus. Competencies: Ability to read and interpret documents such as safety, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or Associates of the organization. Excellent presentation skills General mathematical skills to include basic adding, subtracting, multiplication and division Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form. Exhibit sound and accurate judgment and demonstrate accuracy and thoroughness. Ability to access, compile and analyze large volume data sets into concise and precise information Ability to understand and analyze metrics Ability to define business processes into manageable components Excellent analytical skills Ability to work independently a well as part of a team Ability to multitask Ability to prioritize essential responsibilities to ensure that business needs are met Excellent organizational skills Ability to work onsite and participate in interactive onsite meetings on a regular and predictable basis. Ability to initiate immediate interaction, coordination and collaboration with team members, clients, customers etc. - provided by Dice

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