EDI Analyst

Overview

The EDI Analyst is accountable for developing best business practice knowledge and supporting the business in integrating into the EDI solutions (standards and non-standard EDI systems). The EDI Analyst will also be assisting EDI team in maintaining and running processes/jobs for electronic claims and other EDI transactions which include working with external trading partners, transferring data through secure channels, loading the data to the production environment, and testing files from new providers/trading partners.

Responsibilities

• Work with providers, clearing houses, 3rd party vendors, and software companies to facilitate exchange of HIPAA-compliant ANSI X12 EDI transactions between PHC and its trading partners.
• Coordinate testing the electronic transactions with trading partners and other certification authorities for projects such as ICD-10 and CORE.Assist EDI team in diagnosing problems with inbound claims, providing assistance to Claims, Member Services, and Provider Relations department staff.
• Work with internal and external implementation teams and work cross-functionally between the business and IT to resolve technical issues.
• Meet with end-users inside and outside of PHC and collect the requirements for developing EDI applications.
• Develop SDLC (Software Development Life Cycle) documents such as Business Requirement Document, Process Flow, Business Case Study Document, and Test Case Document.
• Research, analyze, and evaluate technical requirements and specifications for the seamless integration of EDI solutions.
• Analyze and complete EDI requests on time and with high quality including resolving trouble tickets and providing technical solutions.
• Work with programming staff on data formatting/mapping of electronic data and transmission related tasks and issues.
• Develop and maintain the documentation for each interface including policies and procedures related to the highly complex integrated EDI interfaces.
• Assist EDI team in maintaining and running processes/jobs for electronic claims and other EDI transactions using tools such as Active Batch and Oracle TOAD.
• Gain better understanding on the HIPAA-compliant 5010 TR3 specification documents.
• Review EDI development work for compliance within the established state and federal guidelines.
• Participate in negotiation of trading partner agreement and provide assistance to providers in preparing HIPAA-compliant transactions for PHC.

SECONDARY DUTIES AND RESPONSIBILITIES

• Participate in special projects and assignments as needed.

Qualifications

Education and Experience

Bachelor’s degree in a related field, or equivalent combination of education and experience. Minimum one (1) year of EDI involvement in healthcare. Experience developing SDLC (Software Development Life Cycle) documents such as Business Requirement Document, Process Flow, and Business Case Study documents are added advantage. Comparable education and experience as an alternative. RDBMS experience to write simple SQL queries is required.

Special Skills, Licenses and Certifications

Understanding of HMO claims/billing processes; communicate effectively with inside staff and outside sources; ability to research and work with outside providers in a multitude of complex environments; Basic SQL commands for electronic table maintenance. Valid California driver’s license and proof of current automobile insurance compliant with PHC policy are required to operate a vehicle and travel for company business.

Performance Based Competencies

Excellent interpersonal, team, customer service, and communication (written and verbal) skills with ability to assess and resolve problems and issues in an efficient and effective manner; strong project management skills.

Work Environment And Physical Demands

Ability to use a computer; 40-50% of work time is spent in front of a computer monitor; frequent phone usage.

All HealthPlan employees are expected to:

• Provide the highest possible level of service to clients;
• Promote teamwork and cooperative effort among employees;
• Maintain safe practices; and
• Abide by the HealthPlan’s policies and procedures, as they may from time to time be updated.

HIRING RANGE:

$55,039.22 - $67,422.44

IMPORTANT DISCLAIMER NOTICE

The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.