EDI Analyst III

SKYGEN

6h•Remote

About The Position

Act as a main point of contact and subject matter expert for EDI file exchanges and setting up new EDI processes on behalf of clients, (including support for various assigned tasks and initiatives as directed by department leadership) OR act as main point of contact and subject matter expert for EDI encounter files exchanges, analysis and error corrections. Provide appropriate proactive communication to internal and external team members to reduce escalations overall and ensure efficient and compliant operations. Process, troubleshoot, and deliver EDI files.

Requirements

Bachelor’s degree in Information Technology, Computer Science, or related field or equivalent years of internal experience.
Minimum of 5 years of related experience or equivalent advanced education
Experience in demonstrating informal leadership skills
Strong knowledge of database application and data query protocol (MS SQL Server, Transact-SQL).
Strong problem diagnosis and resolution skills.
Strong verbal and written communication skills
Ability to resolve complex problems.
Ability to work autonomously
Good problem solving and decision making abilities
Conflict management skills.
Ability to successfully have conversations with others regarding challenging/sensitive topics.
Ability to adapt to changing priorities quickly
Ability to demonstrate professional behavior
Ability to work overtime as needed.
Strong Medicare and Medicaid experience, plus proficiency in SQL.
Candidates should have a strong foundation in development and should have previous experience working with insurance, processing eligibility (834) or encounter (837) file submissions.

Nice To Haves

Master’s degree in Information Technology or equivalent field of study.
Previous EDI experience.
Knowledge of HIPAA requirements

Responsibilities

Process, troubleshoot, and deliver daily EDI files and reports to clients within required timeframes.
Process inbound and outbound client files including analyzing data for accuracy and preparing a summary of data for clients.
Work collaboratively with external vendors to gather necessary information for new set up.
Set up new EDI processes on behalf of new vendors by assessing current system capabilities, providing proper solutions, testing outcomes, and providing general communication and support as needed.
Work collaboratively with complex and/or larger clients throughout implementations by gathering requirements, validating files, inputting edits, testing files, and ensure compliance and accuracy.
Track inbound and outbound file stats and provide an accounting of data received/sent.
Troubleshoot escalated file processing errors.
Act as primary resource for department projects.
Participate in client and state audits.
Regularly attend and participate in client and internal meetings as a representative of the EDI Department.
Deliver ad hoc data to internal and external customers as appropriate surrounding problems affecting client eligibility and claim processing.
Work collaboratively with internal departments to secure and maintain effective relationships.
Act as a subject matter expert for high priority items sent to the EDI team; answering questions to internal and external contacts and resolving matters that may fall outside of the established workflows.
Respond timely and accurately to client inquiries regarding reported data, incoming client eligibility and outgoing client claims, encounter, provider and other information.
Prepare ad hoc data extracts, reports, and analysis.
Perform routine and ad hoc data maintenance.
Properly communicate technical information to internal and external clients to ensure shared understanding.
Provide training to new and current department staff to ensure understanding.
Work collaboratively with internal teams to keep them informed of potential issues and/or concerns.