Healthcare EDI Analyst, Sr. jobs in the United States

Healthcare EDI Analyst, Sr. provides technical support during and after implementation for electronic data interchange applications used in healthcare settings. Responds to inquiries from vendors, payors, and providers regarding EDI issues with enrollment, claims, payments, and clearinghouse activities. Being a Healthcare EDI Analyst, Sr. troubleshoots problems and deploys solutions to resolve issues. Conducts root cause analysis to prevent future problems and to suggest improvements. Additionally, Healthcare EDI Analyst, Sr. may require a bachelor's degree. Typically reports to a manager. The Healthcare EDI Analyst, Sr. occasionally directed in several aspects of the work. Gaining exposure to some of the complex tasks within the job function. To be a Healthcare EDI Analyst, Sr. typically requires 2 -4 years of related experience. (Copyright 2024 Salary.com)

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Healthcare Analyst
  • EDI Staffing, an EDI Specialists Company
  • Valley Stream, NY FULL_TIME
  • Summary:


    The Analyst acts as the primary liaison between IT and the operational departments within the organization. This position functions in a trusted advisor role. This position will primarily support the Claims functional area of the organization with a strong focus on Healthcare EDI data sets. This includes submissions to the NYS Medicaid, Managed Care, and CMS for Medicare claims.


    Duties and Responsibilities:

    • Testing, including the creation of test scenarios, test data and understanding of outcomes
    • Responsibilities include but are not limited to knowledge of claims editing and adjudication, product regulations and encounter transactions/submission/ recovery.
    • Keeps current with industry trends and state/federal compliance initiatives
    • Supports clients and coworkers
    • Communicates internally and externally with all levels of employees including senior management
    • Identifies issues and facilitates problem resolution
    • Serves as technical and subject matter expert for claims data and claim processing life cycle
    • Analyzes and queries data; has knowledge of the EDI files.
    • Data mapping, including the creation of file specifications, production, and test EDI files.
    • Research new programs and billing rules and communicates his finding to the development team.
    • Testing, including the creation of test scenarios, test data and understanding of outcomes. Provides in-depth analysis to resolve any potential issues prior to new updates being pushed to production.
    • Manages the technical efforts associated with implementing complex EDI trading partners.
    • Participates in implementation meetings with clients and vendors when necessary.
    • Provide HIPAA-compliant guidance and billing guidance to trading partners requesting additional information about industry standards and requirements.
    • Performs routine and ad hoc analysis of various facets of EDI processing including but not limited to system performance, claim turnaround times, data mapping, and claim volumes.
    • Builds and maintains positive working relationships with internal colleagues (including IT, Sales and Marketing, Implementation, Operations and Billing) and external contacts.
    • Attends onsite and offsite meetings with clients, payer representatives or state agencies.
    • Provides coverage for other team members as needed; some on-call support duties may be required. Performs demos when necessary.
    • Assists with hiring and training of new employees. Prepares and conducts internal training as well as client training via Go To Meeting or remotely.
    • Communicates potential solutions to management. Implements solutions.
    • Implements process improvements to enhance the efficiency of the EDI processes.
    • Performs other related duties as assigned.


    Skills:

    • Minimum 2-3 years previous experience as an Analyst
    • Healthcare industry experience
    • Strong data analytics skills
    • Previous experience and business knowledge with health care claims adjudication systems, including the end-to-end life cycle of a claim, EDI 837 and 835 transactions
    • Knowledge of Claims Billing (procedure codes, modifiers, diagnoses) a plus
    • Knowledge of health care benefits and product offerings including NY State of Health exchange plans, Medicaid, Medicare, Dual, Child Health Plus and Managed Long Term Care programs a plus

    Education/Experience:

    • Bachelor's Degree or Higher.



    Computer Skills:

    • Advanced knowledge of Microsoft Office particularly Excel as well as EDI files (835, 837, 277, 277CA, 999, etc.).
  • 9 Days Ago

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Healthcare Analyst
  • EDI Specialists, Inc.
  • Valley Stream, NY FULL_TIME
  • Job Details Summary:The Analyst acts as the primary liaison between IT and the operational departments within the organization. This position functions in a trusted advisor role. This position will pr...
  • 1 Month Ago

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Sr ERP Analyst
  • EDI Staffing
  • Ludington, MI FULL_TIME
  • About: Responsible for managing all aspects of the Plex ERP platform. Act as lead contact for ERP related issues and requests. Work with internal and external partners to problem solve and develop sol...
  • 1 Month Ago

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Sr. SAP Business Analyst Order to Cash
  • EDI Staffing, an EDI Specialists Company
  • Dunmore, PA FULL_TIME
  • Job Details Responsible for gathering business requirements and developing high-level approach to solutions. Candidate will work with both business users and the technical teams to develop processes a...
  • 7 Days Ago

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Sr. SAP Business Analyst Warehouse Management
  • EDI Staffing, an EDI Specialists Company
  • Dunmore, PA FULL_TIME
  • Job Requirements : Candidate should have an in-depth knowledge of SAP supply chain modules (MM, SD, WM). Candidate to be responsible for gathering business requirements and developing high-level appro...
  • 2 Months Ago

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Sr. Financial Analyst - Roselle, IL
  • Signode -Sr. Financial Analyst
  • Roselle, IL FULL_TIME
  • Sr. Financial Analyst - Roselle, IL Apply Now Description/Job Summary About Signode:With over $2B in revenue, 80 manufacturing facilities across 6 continents and over 9,000 employees worldwide, Signod...
  • 4 Days Ago

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Intelligence Analyst - Active Top Secret/SCI eligible
  • General Dynamics Information Technology
  • Sterling, VA
  • The DHS/ICE Visa Security Program (VSP) is part of the International Operations Division of the ICE Homeland Security In...
  • 7/19/2024 12:00:00 AM

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ABA Behavior Therapist / Registered Behavior Technician (RBT)
  • Continuum Behavioral Health
  • Ashburn, VA
  • Job Description Job Description Continuum is in search of qualified, passionate, active and enthusiastic individuals to ...
  • 7/18/2024 12:00:00 AM

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Registered Behavior Technician
  • New Hope Health Co
  • Ashburn, VA
  • Job Description Job Description Are you energetic, purpose-driven, and believe learning through fun is the best way to t...
  • 7/18/2024 12:00:00 AM

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Informatician/Health Data Analyst II
  • Centurion Health
  • Sterling, VA
  • Job Details Job Location VA, Sterling - Corporate Office - Sterling, VA Remote Type Fully Remote Position Type Full-Time...
  • 7/18/2024 12:00:00 AM

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Electromagnetic Testing (AET) Sr Project Manager
  • Curtiss-Wright
  • Ashburn, VA
  • Advanced Electromagnetic Testing - Sr Project Manager We are looking for a Senior Project Manager to join our Advanced E...
  • 7/17/2024 12:00:00 AM

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Data Analyst II
  • Centurion Health
  • Sterling, VA
  • Job Details Job Location VA, Sterling - Corporate Office - Sterling, VA Position Type Full-Time Education Level Bachelor...
  • 7/17/2024 12:00:00 AM

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Behavior Technician, Willing to Train
  • Proud Moments
  • Ashburn, VA
  • Overview: We are currently offering up to a 1K bonus to new hires that complete their Registered Behavior Technician cer...
  • 7/8/2024 12:00:00 AM

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Behavior Technician, Willing to Train
  • Proud Moments
  • Brambleton, VA
  • Overview: Proud Moments ABA is a national behavioral health organization, providing the gold standard of Applied Behavio...
  • 7/8/2024 12:00:00 AM

Income Estimation for Healthcare EDI Analyst, Sr. jobs
$70,355 to $89,923