Reporting to the Manager, Health Plan Implementation Analysts, the EDI Implementation AnalystII role is technical in nature and requires a strong understanding of the interaction between the Availity systems and Availity customers, primarily from a receiver perspective. The EDI Implementation Analyst II role focuses on moderate to complex implementation tasks and responsibilities. The role is accountable for assessing, analyzing, and implementing solutions in a timely and efficient manner.

Key responsibilities include, but are not limited to a) managing internal and external relationships with payers and vendors to meet integration objectives set by Program Management; b) creating appropriate documented deliverables, managing deliverables, gaining agreement from internal and external partners; and c) coordinating partner awareness on Availity functionality as requested by Program Management and production issues as requested by internal teams, including but not limited to Operations support team and/or Information Technology team.

Sponsorship, in any form, is not available for this position.

Location: Remote, US

To be qualified for the role, you have:

• Bachelor's degree or the equivalent work experience
• 4+ years of related experience in a technology (information exchange) and/or healthcare environment
• 4+ years of experience with managing simple to moderately complex implementations and delivering results with speed, accountability, and trust
• Knowledge of the health care industry specifically claims processing systems, provider office operations, and customer service processes in a health care company
• Understanding of HIPAA implementation guides for claim and other transactions
• Knowledge of the health care industry HIPAA mandated ANSI transaction formats.
• Must have a working knowledge of X12 transactions specifically 837P, 837I, 835, 270/271, 276/277, 278, CCR/CCD
• Ability to create and execute test plans
• Ability to create documentation such as training resources and reference materials
• Ability to establish and maintain effective working relationships, supporting internal and external partners
• Excellent written and verbal communication skills including strong presentation skills and the ability to present executive summaries in a concise manner
• Ability to effectively manage multiple priorities in a fast-paced environment
• Flexibility and ability to embrace change
• Ability to prepare documented customer requirements
• Experience with Submitters, Vendors and/or Receivers/Payers is a plus
• Customer service and/or relationship management experience is a plus
• Experience in software implementations is a plus

What you will be doing:

Solutions Integration

Implementation Planning:

• Accountable for all complexity level implementations, including but not limited to submitters, partners, and vendors; to exchange all transaction types through methods such as EDI, B2B, web transactions, API, and others as defined implementations. Tasks involve managing client timelines and deliverables, issue resolution, file transmission, response reporting, testing and results delivery based on customer requirements using Availity processes and tools
• Acts under the guidance of the Level III EDI Implementation Analysts
• Will be responsible for Analyst level tasks of all implementations. Including, but not limited to, developing the implementation plan for all new implementation requests (direct receiver/payer, and partner and vendor), initiating implementation plan with customer, creating all tickets required to execute implementation plan completely.

Implementation Tracking and Execution:

• Manages multiple moderate to complex implementations, including timelines, issue resolution and results delivery using Availity standard tools and processes
• Assesses and analyzes moderately complex standard and non-standard implementations, including HIPAA rules and Availity standards and options and follows processes accordingly
• In partnership with external and internal stakeholders, the EDI Implementation Analyst II conducts pre-production functional testing protocols, including creating and executing test plans for the implementation
• Tracks progress of specific implementation projects via Availity tools including JIRA, Confluence and Salesforce

Resource Coordination:

• Mentors EDI Implementation Analysts to ensure projects are completed on a timely basis and ensures Availity standards are followed.
• Interacts with Payer/Trading Partner, Vendor and Provider Marketing, Business Development, Business Technology Solutions, Product Management, Finance, and Operations
• Communication and coordination between all Availity platforms- (HEW, Patient Access, RCM)
• The EDI Implementation Analyst II will be engaged in providing estimates of work for implementations for submitters, partners and vendors when required.
• The EDI Implementation Analyst II is responsible for managing the workflow of moderate to complex implementations and any other responsibilities of the EDI Implementation Analyst II and ensuring all commitments are maintained.

Customer Relationship Management:

• Interacts with business, technical, internal and external resources on new and existing implementation solutions and partners. The EDI Implementation Analyst II will be required to represent the company in a professional manner to external customers with supervision as needed.
• Assists the Channels Sales, Account Management, and Payer Solutions staff in finalizing opportunities by providing technical guidance to external stakeholders.
• Ensures market validation (utilization) of solution by driving clean hand off to account management or operational support teams.
• Communicates new implementations and all related changes including detailed specifications
• Monitors customer communications (submitter, payer, trading partners, etc) to be apprised of any changes that may impact business operations (new edits, connectivity updates, system downtime)
• Interacts closely with other technology teams and development staff to ensure requirements able to be met accurately and executed within the expected timeline for the implementations.

Operations Support

Process Documentation and Improvement:

• Leads in the development of Availity support documentation (such as production issues, impact and solutions as it relates to the responsibilities of the EDI Implementation Analyst II).
• Documents moderately complex standard processes (such as standard testing procedures) as necessary for continuous process improvement
• Responsible for documenting all information related to assigned implementations. Including but not limited to submitter and partner and vendor implementations, such as requirements, test plans, contact information, escalation procedures, etc.
• Supports process improvement of workflow, endeavors to stay current with technology trends, industry standards, and Availity strategy - specifically driving close to cash process for faster and higher quality connectivity solutions.

Customer Support and Issue Resolution

• This role is required to provide support to EDI Implementation Analyst II for operational issues where assistance is needed.
• Supports organization through researching, resolving and documenting operational issues. Must be able to communicate simple to medium business, technical, and HIPAA issues and resolutions
• Supports and maintains implementations by execution of customer maintenance requests including but not limited to change requests, connectivity changes, and edit and enrichment enhancements.
• Responsibilities of support for an EDI Implementation Analyst II include but are not limited to the migration of clearinghouse partner configurations, migration of clearinghouse partner specification documentation, configuration of alternate routes for submitters.
• EDI Implementation Analyst IIs will also be responsible for updating and maintaining payer routing and the payer list to ensure data is accurate. Including validation of payer routes to guarantee satisfaction.

Why work on this team:

• There is a lot of growth opportunity because you get to wear multiple hats and work with multiple teams with this role.
• You build a large knowledge base and get to work with a flexible and fun team.

Next steps:

After you apply, you will receive text/email messages thanking you for applying and then you will continue to receive more text/email messages alerting you as to where you are in the recruitment process.

Interview process:

• Recruiter Video Interview
• Panel Video Interview
• Manager Video Interview
• Senior Leader Video Interview

Video Camera Usage:

Availity fosters a collaborative and open culture where communication and engagement are central to our success. As a remote first company, we are also camera-first and provide all associates with camera/video capability to simulate the office environment. If you are not able to use your camera for all virtual meetings, you should not apply for this role.

Having cameras on helps create a more connected, interactive, and productive environment, allowing teams to communicate more effectively and build stronger working relationships. The usage of cameras also enhances security and protects sensitive company information. Video participation is required to ensure that only authorized personnel are present in meetings and to prevent unauthorized access, data breaches, preventing social engineering, or the sharing of confidential information with non-participants.