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EDI File Analyst
Fully Remote
* AZ, FL, GA, IL, IN, KS, KY, MI, NJ, NY, OH, OK, SC, TN, TX
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Description
Job Summary:
The Electronic Data Interchange (EDI) File Analyst is responsible for providing support to clients and internal team partners before, during and after the implementation of a client’s electronic enrollment file (834). This includes responsibility for managing the documentation and implementation of clients' requests as well as other types of electronic data files. The EDI File Analyst is also responsible for providing ongoing technical/business support to clients or their designated vendors.
Duties And Responsibilities
* Project manage implementation of the various electronic enrollment options.
* Consult with client or their designated vendor during the implementation process to determine any special processing and system requirements to implement an automated enrollment process.
* Develop and conduct testing of file implementations; as the main point of contact, coordinate and communicate internally and externally until fully implemented with ongoing support for problem resolution.
* Prepare the electronic enrollment presentation materials including implementation schedules necessary for implementing a new electronic enrollment client or migrating a client to EDI file processing.
* Audit inbound and outbound files; reconcile errors and findings. Make decisions based on analysis for problem resolution, downstream impact mitigation and improved efficiency.
* Analyze impact of new benefits/products and other business needs on existing manual and automated processes and propose alternatives. Develop and design solutions to customer business problems and requirements. Quantify the cost and business benefits of the alternative solutions and make recommendations. Develop user requirements to propose the most feasible, cost-effective solution to address the request and promote continuous improvement.
* Recommend procedure and system changes to provide a more effective and efficient electronic enrollment process.
* Develop complete and accurate project documentation and implement training programs/materials to assist customers and stakeholders in adapting to system modifications.
* Guide and assist in the training of other team members to develop a thorough knowledge of the role including tasks and client requirements.
* Approve systems and procedure changes to increase automation or improve processing accuracy or timeliness. This can include system release testing, UAT testing, test case creation and the execution of the testing.
Requirements
Required Knowledge, Skills, and Abilities:
* Bachelor’s degree in business administration, healthcare administration, information systems technologies, or computer science preferred
* 3+ years of experience in benefits eligibility, enrollment, or implementation role processing 834 and other files, preferably in a TPA.
* In depth knowledge of the 834 file layout as well as other data exchange files, .XML, file segments and concepts; health insurance plans, employee benefits, and COBRA coverage.
* Demonstrated history of creating process documentation and contributing to improvement in healthcare role(s).
* Experience with Notepad++ or similar platform preferred.
* Solid working knowledge of standard computer applications including MS Word, Excel, Outlook, and PowerPoint
* Ability using a computer which includes expert keyboard and navigation skills and learning new programs
* Communicate clearly and professionally with internal and external customers
* Work effectively individually and as part of a team to achieve established outcomes. Understand other’s roles and empower one another to take responsibility to be successful.
* Demonstrate collaborative interactions with peers to reach a common goal as well as be a resource to team members and internal/external customers
* Pay close attention to detail in all aspects of the job
* Make decisions using available resources and sound judgment
* Maintain confidentiality and discretion
* Identify and resolve problems in a timely manner, gather and analyze information skillfully and proactively
* Share knowledge with associates by effectively communicating and providing follow-up.
* Open to other’s ideas and exhibits a willingness to try new things.
* Demonstrate accuracy and thoroughness; monitor work to ensure quality.
* Prioritize and plan work activities to use time efficiently.
* Adapt to changes in the work environment, manage competing demands and is able to deal with frequent changes, delays, or unexpected events.
* Follows instructions, responds to direction, and solicits feedback to improve.
* Act in such a way to instill trust from management, other associates, as well as customers.
Physical and Cognitive Demands: The demands described here are representative of those necessary for an employee to successfully perform the essential functions of this job. Reasonable accommodation can be made to enable individuals with disabilities to perform the essential functions.
* Constant: Talk, hear, speak, and use hands and fingers to operate a computer, telephone, keyboard/mouse; occasionally move about the office
* Constant: Visual ability such as close vision, distance vision, color and peripheral vision, depth perception and ability to adjust focus; ability to detect differences in color shades and brightness
* Occasional: Lift and/or move up to 10 pounds
* Constant: Regular, predictable attendance is required
* Constant: While performing the duties of this job, the employee is regularly sitting for the full shift.
* Constant: The cognitive skills needed to complete tasks include abilities such as learning, remembering, focusing, categorizing, and integrating information for decision making, problem-solving, and comprehending.
Work Environment: The work environment described is representative of what must be met by an employee successfully to perform the essential functions of this job.
* The physical environment is indoors in a controlled climate, office setting. The noise level may be low to moderate.
The duties described are representative, but not restrictive of tasks that may be assigned or of the abilities required to do the job. The description is subject to change at any time. Other related duties may be assigned. This description does not alter the at-will status of employment.
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