Job at a glance
Description Top Skills' Details - 1 to 3 years experience (1 years minimum) working with healthcare data - Able to do some basic queries of data (they don't need to write queries from scratch, rather just use pre-built queries and then load data into a new Data Transfer system called MoveIt) - MUST have a computer oriented degree like Information Systems, Analytics, Computer Science, etc. BACKGROUND Our client is going live with a new Claims System called HRP and a new File Transfer system.
The system will be integrated with the client's Claims System and their Electronic Data Interchange (EDI) system which transfers payments to their Providers for medical services provided to their customers. This role will initially support Pre Go-Live activities by leveraging their healthcare data experience and SQl skills by getting their 3,000 Providers’ accounts set-up in MoveIt and then Go-Live activities supporting both MoveIt as well as the Claims System.
Those Go-Live activities will include supporting customers, through both email and phone activities, when payments aren’t received as expected. Although heavy troubleshooting skills will not be required, the successful candidates will need to investigate why a payment failed to process, using a pre-built script of outlined activities and then escalate the issue to technical support, the Claims Operations Team or another department as needed.
Because the selected candidates will be both getting up to speed and participating in Pre and Post Live Activities, this role will need to be onsite five days each week. After the initial contract period, which goes through March 3, there will be an opportunity to transition to a hybrid two days onsite/week once the platforms have been stablized. POSITION PURPOSE The Data Analyst (EDI) is accountable for developing best business practice knowledge and supporting the business in integrating into the Electronic Data Interchange (EDI) solutions (standards and non-standard EDI systems).
The Data Analyst (EDI) will also be assisting EDI team in maintaining and running processes/jobs for electronic claims and other EDI transactions which include working with external trading partners, transferring data through secure channels, loading the data to the production environment, and testing files from new providers/trading partners. ESSENTIAL DUTIES AND RESPONSIBILITIES - Work with providers, clearing houses, 3rd party vendors, and software companies to facilitate exchange of HIPAA-compliant ANSI X12 EDI transactions between PHC and its trading partners.
- Coordinate testing the electronic transactions with trading partners and other certification authorities for projects such as ICD-10 and CORE.Assist EDI team in diagnosing problems with inbound claims, providing assistance to Claims, Member Services, and Provider Relations department staff. - Work with internal and external implementation teams and work cross-functionally between the business and IT to resolve technical issues.
- Meet with end-users inside and outside of PHC and collect the requirements for developing EDI applications. - Develop SDLC (Software Development Life Cycle) documents such as Business Requirement Document, Process Flow, Business Case Study Document, and Test Case Document. - Research, analyze, and evaluate technical requirements and specifications for the seamless integration of EDI solutions. - Analyze and complete EDI requests on time and with high quality including resolving trouble tickets and providing technical solutions.
- Work with programming staff on data formatting/mapping of electronic data and transmission related tasks and issues. - Develop and maintain the documentation for each interface including policies and procedures related to the highly complex integrated EDI interfaces. - Assist EDI team in maintaining and running processes/jobs for electronic claims and other EDI transactions using tools such as Active Batch and Oracle TOAD.
- Gain better understanding on