EDI Business Implementation Analyst

System One; Dayton (OH); Remote; USD 80,000 - 110,000; Full time

Job summary

A leading provider of workforce solutions is seeking an EDI Business Implementation Analyst for a 7-month remote contract. The role involves leading implementations in healthcare EDI systems, ensuring compliance, and collaborating with various departments to facilitate smooth operations. Candidates should have experience in EDI, SQL, and strong communication skills.

Qualifications

• 5 years health care operations experience in insurance or managed care.
• 3-5 years SQL experience required.
• Advanced knowledge of healthcare EDI files.

Responsibilities

• Lead eBusiness implementations and coordinate across functional areas.
• Manage EDI transactions setup, testing, and validation.
• Develop and document business requirements for claims processing.

Skills

EDI skills

Data analysis

Communication

Time management

Education

Bachelor’s degree or equivalent experience

Job description

Title:EDI Business Implementation Analyst - 2 roles are open
ALTA is supporting a 7-month contract opportunity working 100% remote.

ALTA IT Services is a wholly owned subsidiary of System One, a leading provider of specialized workforce solutions and integrated services. ALTA is an established leader in IT Staffing and Services, for both government and commercial enterprises across the United States, specializing in Program & Project Management, Application Development, Cybersecurity, Data & Advanced Analytics, and Agile Transformation Services.

We now have (2) openings for an EDI Business Implementation Analyst.

The EDI Business Implementation Analyst is responsible for leading eBusiness implementations and coordination of activities across multiple functional areas. Edifecs Transaction Management knowledge required.

Skills Needed: Seeking good EDI skills and implementing EDI systems, what we need is Implementing new contracts (Medicaid, Medicare, Marketplace) with expertise in EDI so they can identify gaps and ensure testing runs smooth.

Essential Functions:

• Coordinate and support the implementation of new Medicaid, Commercial and Marketplace lines of business by ensuring claims intake requirements are clearly defined and met
• Manage setup, testing and validation of EDI Transactions (837,999 ,277CA, 278, 270/271, 276/277, etc.) to ensure compliance with HIPAA and payer specific requirements
• Oversee workflows and systems for intake, imaging and data capture of paper claims ensuring timely and accurate conversion to electronic format
• Partner with IT, Provider Services, Configuration, Claims Operations and eBusiness Leadership to ensure smooth integration and readiness for go-live activities.
• Develop and document business requirements for claims intake and processing, ensuring alignment with regulatory and operational standards
• Design and execute test plans for claims intake systems and processes, including EDI and paper claims to ensure accurate data transmission and adjudication
• Identify, analyst and resolve issues related to claims intake and data discrepancies during implementation and ongoing operations
• Ensure all claims intake process comply with CMS, state Medicaid and other regulatory requirements specific to each line of business
• Track key performance indicators related to claims intake timeliness, accuracy and rejection rates. Provider actionable insights to stakeholders
• Develop training materials and process documentation to support internal staff and stakeholders understanding new business specific rules

Education and Experience:

• Bachelor’s degree or equivalent years of relevant work experience is required
• Minimum of five (5) years of health care operations experience in insurance, managed care, or related industry is required
• 3-5 years of SQL experience required including the ability to write and execute complex queries

Competencies, Knowledge and Skills:

• Advanced knowledge of healthcare EDI files (837, 277CA, 999, 270/271, 276/277, etc.)
• Advanced knowledge of ANSI X12 guidelines includes syntax, editing requirements and best practices
• Advanced computer skills in Microsoft Word, Excel, Outlook & Visio
• Demonstrated exceptional communication (verbal and written) and high level of professionalism
• Data analysis and trending skills to include query writing Knowledge of Claims IT processes and systems
• Working knowledge of managed care and health claims processing
• Ability to effectively interact with all levels of management within the organization and across multiple organizational layers
• Demonstrates excellent analysis, collaboration skills, facilitation and presentation skills
• Strong interpersonal, leadership and relationship building skills
• Effective decision making and problem-solving skills
• Ability to work independently and within a team environment
• Time management skills; capable of multi-tasking and prioritizing work
• Attention to detail
• Critical thinking and listening skills
• Facets knowledge preferred
• Knowledge of Agile framework preferred

Licensure and Certification:

• None

Ref: #860-IT Cincinnati