EDI Analyst III

Central California Alliance for Health; California (MO); Hybrid; USD 78,000 - 138,000; Full time

Job summary

Join a forward-thinking organization as an EDI Analyst, where you will play a pivotal role in optimizing healthcare delivery through innovative technology solutions. This position involves leading EDI transaction implementations, ensuring secure data transmissions, and providing expertise in healthcare business analysis. Your contributions will directly impact the efficiency of healthcare services and enhance the connections between staff, members, and providers. If you are passionate about making a difference in the community and thrive in a collaborative environment, this opportunity is for you. Embrace the chance to work with a dedicated team committed to quality health care and innovation.

Benefits

Medical, Dental and Vision Plans

Ample Paid Time Off

12 Paid Holidays per year

401(a) Retirement Plan

457 Deferred Compensation Plan

Robust Health and Wellness Program

Onsite EV Charging Stations

Qualifications

• 5+ years of business analysis experience in a Medi-Cal or managed care environment.
• Thorough knowledge of HIPAA EDI protocols and healthcare business analysis.

Responsibilities

• Lead implementation of new EDI transactions and maintain accuracy of healthcare EDI processes.
• Manage relationships with trading partners and oversee secure data transmission.

Skills

Data Analysis

Requirements Assessment

Project Management

Problem Solving

Communication Skills

Education

Bachelor's degree in Information Technology

Master's degree in related field

Tools

SQL

SFTP

Microsoft Teams

Job description

We have an opportunity to join the Alliance as a EDI Analyst in the Applications Services Department.

WHAT YOU'LL BE RESPONSIBLE FOR

Reporting to the EDI Manager, this position:

• Leads the implementation of new EDI transactions, x12 and proprietary, including data analysis, requirements assessment and gathering, and solution design and testing
• Performs deep dive analysis and maintains the accuracy of production healthcare EDI transactions and processes, including encounter data oversight
• Manages relationships with trading partners, such as providers, vendors, and regulatory agencies
• Oversees Secure File Transfer Protocol (SFTP) processes to ensure secure transmission of EDI data
• Provides subject matter expertise and assists with providing mentoring and training

ABOUT THE TEAM

The applications we build, purchase, integrate and customize are what allows the Alliance staff, members, and providers to connect with each other effectively and efficiently in order to optimize health care delivery. Deploying these tools is just one phase of our ongoing work. We also focus on health care technology innovation in line with the ever-changing health care landscape.

THE IDEAL CANDIDATE

• Experience working in a Medi-Cal and/or Medicare environment
• Experience managing SFTP file transfers and ensuring secure data transmission across healthcare EDI transactions
• Thorough knowledge of advanced SQL
• Thorough knowledge of healthcare business analysis

WHAT YOU'LL NEED TO BE SUCCESSFUL

• Knowledge of:
  • HIPAA EDI protocols
  • Current technology transmissions and receipt methods and the requirements of electronic data submissions
  • Software product lifecycle management, from defining requirements to implementation
• Ability to:
  • Manage multiple projects simultaneously, organize work, maintain accurate records, respond to changing priorities, and achieve goals and timelines
  • Define issues, collect and interpret complex data, develop solutions, project consequences of recommendations, and prepare written reports
  • Demonstrate flexibility and creativity, identify improvements to existing practices, and effectively adapt to change
• Education and Experience:
  • Bachelor's degree in Information Technology, Computer Science, Computer Engineering, Healthcare or a related field and a minimum of five years of business analysis experience in a Medi-Cal or managed care environment (a Master’s degree may substitute for two years of the required experience); or an equivalent combination of education and experience may be qualifying

OTHER INFORMATION

• We are in a hybrid work environment and we anticipate that the interview process will take place remotely via Microsoft Teams.
• While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected.
• In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process.

THE FULL COMPENSATION RANGE FOR THIS POSITION IS LISTED BY LOCATION BELOW.

The actual compensation for this role will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferrable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location).

TYPICAL AREAS IN ZONE 1: Bay Area, Sacramento, Los Angeles area, San Diego area

TYPICAL AREAS IN ZONE 2: Fresno area, Bakersfield, Central Valley (with the exception of Sacramento), Eastern California, Eureka area

ZONE 1: (Monterey, San Benito and Santa Cruz) $86,203.56 - $137,945.60 USD

ZONE 2: (Mariposa and Merced) $78,445.54 - $125,528 USD

OUR BENEFITS

Available for all regular Alliance employees working more than 30 hours per week. Some benefits are available on a pro-rated basis for part-time employees. These benefits are unavailable to temporary employees while on an assignment with the Alliance.

• Medical, Dental and Vision Plans
• Ample Paid Time Off
• 12 Paid Holidays per year
• 401(a) Retirement Plan
• 457 Deferred Compensation Plan
• Robust Health and Wellness Program
• Onsite EV Charging Stations

ABOUT US

We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us.

Join us at Central California Alliance for Health (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non-profit health plan, we serve members in Mariposa, Merced, Monterey, San Benito and Santa Cruz counties. To learn more about us, take a look at ourFact Sheet.

The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status. We are an E-Verify participating employer.

At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.

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