EDI Analyst

Job Details

Corporate Headquarters - Chula Vista, CA

Full Time

$95839.91 - $134175.87 Salary

Description

POSITION SUMMARY

The EDI Analyst will work within a team of developers and analysts to plan, design, implement, and test Electronic Data Interchange (EDI) systems in support of Community Health Group’s (CHG) core Medi-Cal and Medicare insurance programs. The EDI Analyst will ensure that intensive business analysis, detailed architectural design, and thorough planning are all incorporated in each of CHG’s EDI Processes to ensure the highest level of data quality. Frequently the EDI Analyst will meet with the appropriate business users to determine business needs and to gather information in order to define and develop EDI related processes, reports, and applications. This position will also provide technical assistance to Information Systems (IS) staff, and develop written documentation such as specifications and operational procedures.

COMPLIANCE WITH REGULATIONS:

Works closely with all departments necessary to ensure that the processes, programs and services are accomplished in a timely and efficient manner in accordance with CHG policies and procedures and in compliance with applicable state and federal regulations including CMS and/or Medicare Part D, DHCS, and Council for Affordable Quality Healthcare Committee on Operating Rules for Information Exchange (CAQH CORE).

RESPONSIBILITIES

This position will be involved in multiple activities related to Community Health Group’s EDI operations which include:

Research and design new EDI processes to import, transform, and export data to support business objectives.

Document EDI Processes, requirements, and test plans.

Design, develop, implement, and maintain EDI x12 transactions and processes.

Design, purchase, or configure EDI Applications with Software Developers or Vendors.

Configure QNXT EDI modules and trading partners.

Work with Clearinghouses to resolve issues.

Apply standard configurations for other EDI components including: BizTalk, TIBCO, MoveIT, and SFTP servers.

Analyze, process, and troubleshoot HIPAA/EDI X12 ANSI 5010 healthcare transactions using the following specifications:

ANSI x12 EDI HIPAA transaction sets: 820, 834, 274, 270/271, 276/277, 277CA, 835, 837 P/I, 999

HL7, XML, FHIR

DHCS pharmacy encounter data NCPDP File

Ensure CHG’s compliance with regulations and the stability of business operations by:

Monitoring and maintaining EDI exchanges and transaction processing and maintaining the accuracy of production healthcare EDI transactions and processes

Diagnosing and resolving system issues related to EDI processes.

Developing ad-hoc reports related to EDI and Encounter data

Assisting with Data submissions and tracking data quality and timeliness metrics.

Auditing data to ensure the accuracy of information supplied to/from providers and trading partners.

Managing daily production EDI processes

Developing and maintaining documentation of EDI requirements, specifications, companion guide, user guide, and desktop procedure.

Research new EDI data regulations and quality measurements and present information to team members.

Understanding and supporting CHG’s Risk Adjustment process.

Creating Policy and Procedures

Understanding the Medicare Plan Communications User Guide.

5. Provide timely communication on status and issues on a weekly basis

6. Other duties as assigned

Qualifications

Education:

Bachelor’s degree in Information Technology, science, technology, engineering, or mathematics (STEM) field or other fields with related experience.

Experience/Skills:

Minimum of 2 years of professional experience.

Proficient in database analysis and able to write advanced SQL queries and understanding stored procedures.

Ability to write SQL queries, and understand how data is stored within Microsoft SQL Server databases

Ability to collect requirements into design documents.

Ability to break down work into discreet tasks and manage projects.

Accuracy, attention to details, and problem solving skill

Knowledge of XML

Proficient in EDI transactions

Proficient in HL7 transactions

Knowledge of Risk Score

Knowledge of Biztalk

Knowledge of TIBCO

Excellent oral and written communication.

Excellent time management; able to work on multiple projects concurrently.

Ability to adhere to security requirements and confidentiality as required by the company and HIPAA.

Ability to deliver quality result under tight deadlines

Ability to work independently with minimal supervision

Ability to operate personal computers and other related peripherals

Microsoft Office

Physical Requirements:

May be required to work evenings and/or weekends.

The above statements describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.

Community Health Group is an equal opportunity employer committed to fair and equitable treatment for all employees. We prohibit discrimination and harassment based on any protected characteristic as outlined by federal, state, or local laws. This policy applies to all employment practices within our organization, including hiring, recruiting, promotion, termination, layoff, recall, leave of absence, compensation, benefits, and training. Community Health Group makes hiring decisions based solely on qualifications, merit, and business needs at the time.