EDI Systems Analyst

Job Description

Hours: Full Time; Monday - Friday; 8:30 - 5:00
Location: The Polyclinic 1145 Broadway
Position Objective :

To support existing EDI (Electronic Data Interchange) claims transactions, identify and resolve transactional issues, analyze new customer requirements, coordinate testing with customers for new map implementations.

Responsibilities:

• Develop and maintain existing and new data maps for claims inbound and outbound encounters including EDI ANSI X12 standards versions 5010, for 837 transactions.
• Develop automation solutions to increase productivity and efficiency for FTP exports and imports.
• Analyzes, designs, develops, implements and maintains EDI related projects and provides electronic submittal of reports to Health Plans and outside vendors.Responsible for technical support, systems operation and documentation.
• Provides coordination with health plans and outside vendors for proper claim retrieval, processing and reporting.
• May be responsible for documentation and submittal of all EDI-HIPAA processes, policies and procedures.
• Researches and analyzes requests, per priorities established with management, with the ability to generate and manipulate data from multiple sources and/or databases. Generates output in specified formats (i.e. graphics, spreadsheets, databases, etc.)
• Serves as a resource to other departments.
• Serve as a backup to other technical staff as assigned.

Qualifications :

Knowledge and Experience:

• Knowledge of X12 EDI Standards including experience with HIPAA 5010 and ICD-10.
• Demonstrated knowledge of UB-04, HCFA-1500, other claim forms, claims eligibility, claims status, EDI, claims payments, and understanding of setting up and managing electronic transactions.
• Demonstrated knowledge of SQL query development.
• Minimum of 5 years experience in PC-based data collection and reporting, including Microsoft SQL Server development, Access, Excel, or other relational databases.
• Track record of automating process through the development of scripts or applications.
• Experience interacting with clearinghouses.
• Proven ability to manage complex technology projects
• Experience with EZ CAP claims software a plus.
• Experience with complex workflows or business processes
• Proficient in MS-Office applications (Word, Excel, Access, Project, Visio)
• Self directed and adaptive to changing priorities

Skills:

• Strong analytical skills. Specifically the ability to gather and analyze requirements and documents them.
• Strong project and process management skills.
• Ability to work independently and manage multiple tasks and project priorities.
• Ability to report data in various forms including paper reports, spreadsheets, web pages, graphs, presentations, and other operational needs as they may arise.

Technologies:

• Microsoft SQL Server 2008 and Windows XP/ Windows 7 desktop
• SSRS and SSIS
• OLE-DB and ADO
• SQL Server Data Transformation Services
• Programming and scripting languages (e.g., VBScript, VB, .NET)
• Microsoft Excel
• Microsoft Access

Education:

A Bachelor’s degree in computer science or similar field, and 3 – 5 years of experience in a systems EDI analyst role or equivalent combination of education and experience in a systems field/role.