FC
EDI Analyst
First Connect
🇺🇸 United States
On-site
4 weeks ago
- EDI
- CMS
4 weeks ago
Not enough detail in this posting to match
Develops, implements processes and monitors all EDI transactions as it pertains to membership/enrollments.
Minimum Qualifications:
Formal Education Required:
Associates Degree or may substitute with 2 years of like experience.
Experience & Training Required:
3+ years performing same or similar responsibilities. Relevant experience includes: eligibility, enrollment, premium billing, and/or reconciliation responsibilities in a managed care environment, and/or working knowledge of electronic enrollment transactions and 834 files.
Other Skills, Competencies and Qualifications:
Ability to communicate instructional and operational information verbally and in written form that may include correspondence, reports, instructional materials, system designs; ability to provide instruction and guidance required to supervise day-to-day departmental operations; ability to interface with internal staff, mid-upper management professionals and general public.
Collecting, analyzing data from diverse sources; making recommendations and/or conclusions based on analyses; developing financial, data processing technical reports, procedures, systems that usually affect one department.
Demonstrate high degree of organization and attention to detail.
Demonstrate excellent technical skills with the desire and ability to learn new software programs and systems.
Demonstrate initiative and ability to work autonomously in a self-directed manner, and transition easily between working alone and working with groups.
Operate standard office machines.
Organize and manage time to accurately complete tasks within designated time frames in a fast- paced environment.
Maintain current knowledge of and comply with regulatory and company policies & procedures.
Maintain confidentiality of patient and business information.
Flexible: ability to adjust wok hours to meet business demands.
Ability to effectively interact with populations of patients/customers with an understanding of their needs for self-respect and dignity.
Level of Physical Demands:
Sit for prolonged periods of time.
Bend, stoop, and stretch.
Manual dexterity to operate computer, phone, and standard office machines.
7. Essential Functions:
Sets up or modifies Trading Partner Rules for new and existing clients.
Develops mapping specifications for EDI enrollment, and provides technical support and business analysis during and after implementation of 834 EDI applications.
Performs end-user acceptance testing on all inbound and outbound files as them pertain to membership.
Processes new EDI enrollments/changes for new and existing clients.
Investigates transactions rejected by CMS, FFM and other third party vendors, and takes appropriate action in accordance with defined guidelines.
Monitors electronic enrollment transactions in order to identify any issues with load/processing and collaborates with programming and/or clients as needed.
Responds to EDI inquiries and issues from external and internal organizations including trading partners, the state and CMS regarding enrollment transactions.
Collaborates with management in identifying, defining, and documenting process improvement options and alternatives, as directed by business needs.
Promotes and leads process improvement activities and training of department staff and peers.
Creates and maintains policies and procedures related to EDI enrollment transactions.
Performs all job functions with integrity. Provides timely internal and external customer service in a cooperative, professional, and respectful manner.
Note: The above stated duties are intended to outline those functions typically performed by the incumbent in this position. This description of duties is not intended to be all-inclusive nor to limit the discretionary authority of supervisors to assign additional tasks of a similar nature or level of responsibility.
VivPost
EDI Analyst · First Connect