EDI Analyst

Description

POSITION SUMMARY:

The EDI Analyst will be responsible for managing, developing, and implementing electronic data interchange (EDI) systems and processes. This position plays a crucial role in ensuring the seamless exchange of data between the company and its partners, including healthcare providers, clearinghouses, and other third parties. The ideal candidate will have experience with healthcare EDI transactions, a strong technical background, and excellent problem-solving skills.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• EDI Development and Maintenance:
  • Develop, implement, and maintain EDI processes and systems.
  • Create and modify EDI mappings, workflows, and configurations.
  • Ensure compliance with industry standards and regulations (e.g., HIPAA, ACA).
• Data Management:
  • Monitor and manage data exchanges to ensure accuracy and timeliness.
  • Troubleshoot and resolve data discrepancies and errors.
  • Perform regular audits to maintain data integrity.
• Technical Support:
  • Provide technical support for EDI-related issues to internal and external stakeholders.
  • Collaborate with IT teams to integrate EDI systems with internal applications.
  • Work with trading partners to set up and maintain EDI connections.
• Process Improvement:
  • Identify and implement process improvements to enhance EDI operations.
  • Develop and document standard operating procedures and best practices.
• Project Management:
  • Lead and participate in EDI-related projects, including new implementations and upgrades.
  • Coordinate with internal teams and external partners to ensure project timelines and deliverables are met.

QUALIFICATIONS:

The individual in this role must be highly motivated and a self-starter.  The EDI Analyst must be a critical thinker and be able to grasp benefit concepts.  The individual must have strong systems design skills that include integration of systems, translation of concepts, design and documentation activities for others to review and understand, and accuracy of data.  The EDI Analyst must be detail-oriented with the ability to manage multiple priorities and time-sensitive projects. Excellent verbal and written communication skills along with strong interpersonal and problem-solving skills are required.  The requirements listed below are representative of the knowledge, skill, and/or ability required. 

EDUCATION AND/OR EXPERIENCE:

• Education:
  • Bachelor’s degree in Computer Science, Information Technology, or a related field, or equivalent work experience.
• Experience:
  • Minimum of 3-5 years of experience in EDI development and management.
  • Experience in the healthcare industry, particularly with self-funded health insurance, is highly preferred.
  • Familiarity with EDI standards (e.g., ANSI X12, HL7) and transactions (e.g., 837, 835, 834).
• Technical Skills:
  • Proficiency in EDI mapping.
  • Strong understanding of databases and SQL.
  • Experience with scripting languages (e.g., Python, Perl) is a plus.
  • Knowledge of network protocols and data communication methods.
• Desired Experience:
  • Experience with Javelina software.
  • Familiarity with Amazon Web Services (AWS) and Google Cloud Platform (GCP).

COMPETENCIES:

The EDI Analysts should continue to develop the following competencies with an attitude of being a lifelong learner in the fields of employee benefits, insurance and business:  

Client and Personal Service — Knowledge of principles and processes for providing client and personal services. This includes client needs assessment, meeting quality standards for services, and evaluation of client satisfaction. 

Developing Objectives and Strategies — Establishing long-range objectives and specifying the strategies and actions to achieve them. 

Fluency of Ideas — The ability to come up with several ideas about a topic (the number of ideas is important, not their quality, correctness, and creativity). 

Active Listening — Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times. 

Systems Analysis — Determining how a system should work and how changes in conditions, operations, and the environment will affect outcomes. 

Systems Evaluation — Identifying measures and indicators of system performance and the actions needed to improve and correct performance, relative to the goals of the system. 

Communicating with Internal and External Partners — Providing information to partners within and outside the organization by telephone, in written form, e-mail, and in person. 

 Administration and Management — Knowledge of business and management principles involved in strategic planning, resource allocation, human resources modeling, leadership technique, and coordination of people and resources.   

Law and Government — Knowledge of laws, legal codes, and government regulations. 

Evaluating Information to Determine Compliance with Standards — Using relevant information and individual judgment to determine whether events and processes comply with laws, regulations, and standards. 

Organization – Prioritizing workflows based upon client needs, deadlines (internal and external) and available resources; being capable of managing multiple projects at one time. 

Critical Thinking — Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions and approaches to problems. 

Complex Problem Solving — Identifying complex problems and reviewing related information to develop and evaluate options and implement solutions. 

Analyzing Data or Information — Identifying the underlying principles, reasons, and facts of information by breaking down information and data into separate parts. 

Deductive Reasoning — The ability to apply general rules to specific problems to produce answers that make sense. 

Making Decisions and Solving Problems — Analyzing information and evaluating results to choose the best solution and solve problems.  

Updating and Using Relevant Knowledge — Keeping up-to-date technically and applying new knowledge to your job. 

Written Comprehension — The ability to read and understand information and ideas presented in writing. 

Oral Comprehension — The ability to listen to and understand information and ideas presented verbally. 

Monitoring — Monitoring/Assessing performance of yourself, other individuals, and organizations to make improvements and take corrective action. 

Mathematics — Knowledge of arithmetic, algebra, statistics, and their applications. 

Identifying Objects, Actions, and Events — Identifying information by categorizing, estimating, recognizing differences and similarities, and detecting changes in circumstances and events. 

Organizing, Planning, and Prioritizing Work — Developing specific goals and plans to prioritize, organize, and accomplish your work. 

COMPUTER SKILLS:    

To perform this job successfully, an individual should be proficient in all Microsoft Office products and be able to learn new systems within a reasonable time.

PHYSICAL DEMANDS:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to stand, walk, use hands and fingers, talk, and hear. The employee is frequently required to sit and reach with hands and arms. The employee is occasionally required to climb or balance and stoop, kneel, crouch or crawl.  The employee must regularly lift and/or move up to 10 pounds and occasionally lift and/or move 25 pounds or more.  Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception and ability to adjust focus.

WORK ENVIRONMENT:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. The employee will work both in an office environment and remotely from home during typical office hours with occasional overtime. The office environment has moderate temperatures and minimal noise levels.  When working remotely the employee must have a quiet, office-like work environment suitable for phone and web calls, and strictly adhere to HIPAA and privacy regulations.  Occasional travel may be required. 

ADDITIONAL COMMENTS:

This job description is not intended to be a complete list of all responsibilities, duties or skills required for the job and is subject to review and change at any time, with or without notice, in accordance with the needs of Vitori Health.  Since no job description can detail all the duties and responsibilities that may be required from time to time in the performance of a job, duties and responsibilities that may be inherent in a job, reasonably required for its performance, or required due to the changing nature of the job shall also be considered part of the jobholder’s responsibility.

Qualifications

Salary : $68,500 - $76,300