This position performs technical analysis of Electronic Data Interchange (EDI) transactions for production support activities, and assists withdetermining and writing EDI-related requirements. The SR Analyst will be responsible for working in partnership with the IT EDI team to help resolve EDI issues. Will perform analysis of new health plan companion guides and conduct technical research on various EDI topics as needed. Works underlimited supervision and can provide backup leadership to team.
• Maintains working knowledge of CareCentrix systems related to EDI transaction processing.
• Conducts analysis of EDI transactions and claims adjudication.
• Documents EDI issues for both technical and business users.
• Conducts analysis and writes business requirements for system changes, projects and new health plan implementations.
• Possesses excellent communication (verbal/written), organizational and interpersonal skills.
• Maintains working knowledge of EDI industry standards and CAQH Core Rules
• Manage multiple tasks, be detail oriented, be responsive, and demonstrate independent thought and critical thinking.
• Participates in special projects and performs other duties as assigned.
• Works on significant and unique issues where analysis of situations or data requires an evaluation of intangibles. Exercises independent judgment in methods, techniques and evaluation criteria for obtaining results. Creates formal networks involving coordination among groups.
• Acts independently to determine methods and procedures on new or special assignments. May mentor and oversee the activities of others.
Bachelor’s Degree in Information Science, MIS, Computer Science or equivalent. 8+ years of job relevant experience and 5 years of experience in healthcare industry, and EDI transactions. Strong knowledge of HIPAA 5010 healthcare transaction set (particularly the 837, 835, 277 and 270/271) required. Preferred experience writing business requirements and data analysis. Experience writing and executing basic SQL queries for ad-hoc investigation preferred. Experience with EDI Edifices software tools preferred.