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Senior EDI Analyst

  • Location: Frisco, TX
  • Start Date: 6/30/2020
  • Job ID: 20-00319
  • Posting Date: 6/30/2020
  • Job Type: Direct Placement
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Our client, based North of Dallas, is seeing aSenior EDI Analyst with EDI experience particularly dealing with Health Plans. This individual will be responsible for managing EDI through various stages of operation.

This position is responsible for developing, coordinating, and implementing files between outside vendors, clients, and brokers. Responsible for analyzing various specifications to work in conjunction with reports, interfaces, and mappings provided by data-trading partners. They coordinate and work with internal teams to complete EDI testing, implementations, and production processing of EDI files.

Responsibilities:

  • Documentation of EDI automation processes & procedures

  • Responsible for the integration of any new vendor relationship using Electronic Data Interchange and file layouts for eligibility, accumulator, claims, and other files

  • Communicate with TPAs and other vendors to bridge gaps between system partners and internal outward-facing staff

  • Obtain EDI file specifications, file encryption and transmission information from various sources

  • Document scope of work in all stages of integration; noting customizations, routing rules, data mapping, etc.

  • EDI automation setup (Troubleshooting/Testing of any issues)

  • Establish and set up file transfer protocols or other various means of connection with outside vendors

  • Develop various reports to track KPI's, volumes, etc.

  • Partner with Operations to advise of new client set up and other relevant matters surrounding implementation

  • Has solid technical understanding of EDI files (fixed length, delimited, TXT, CSV, XML, X12) in support of claims and eligibility

  • Daily monitoring of EDI file processing, the troubleshooting of issues impacting successful receipt or delivery of client files, the setup and testing of new trading partners, and general customer support of issues called in to the Help Desk.

  • Data file format translations using tools like Pilotfish, Gentran, EDI HQ, BSI, etc.

  • Conduct necessary testing and in-depth analysis to resolve any potential issues prior to rolling trading partners into the production environment

  • Monitor, audit, and report on the processing of newly implemented trading partners to confirm their successful transition to the production environment

  • Development of necessary programs to support EDI transactions and processing

  • Perform routine and ad hoc analysis of various facets of EDI processing including but not limited to system performance, claim turnaround times, data mapping, and claim volumes

  • High level understanding of MS SQL databases and tables

  • Coordination with database team to ensure best practices in data management

  • Ensure compliance with HIPAA regulations and requirements

  • Running reports and report management

  • Build and maintain positive working relationships with internal colleagues (including IT, Sales and Marketing, and Operations) and external contacts

  • Experience building an EDI function from the ground up is desirable

  • Experience in healthcare health plans is required especially in eligibility and claims flow

  • Overseeing the activities of junior level EDI analyst(s)

  • Other duties, as assigned

Qualifications:

To be a part of the team you must meet or exceed the following requirements:

  • BA/BS in business/information systems, finance, math, or a related field preferred

  • 2-4 years of experience with project coordination and/or management

  • 3-5 years of experience with different EDI X12 file formats required

  • Deep experience with 835, 835, 837I, 837P, 270/271, and 997 X12 formats

  • Ability to multi-task

  • Strong interpersonal and communication skills

  • Fluency in Microsoft Office applications, especially Excel and Visio

  • Healthcare domain knowledge required, particularly as it relates to Health Plans.


Posted by Andy Oliver
Technical Recruiting Manager
(800) 821-4644 x 9223

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