The EDI Technical Specialist sets up, maintains, and supports Alliance EDI processes to include business analysis, configuration, coding, peer and quality assurance testing, and final documentation. Incumbents apply professional experience, including analysis, process design, modification, configuration, data mapping and maintenance of application programs, integrated systems, and software solutions.
This position is full-time remote. Selected candidate must reside in North Carolina. Some travel for onsite meetings at the home office (Morrisville, NC) may be required.
Responsibilities & Duties
Core Tasks
Develop a detailed knowledge of the underlying business requirements and available data and support innovative solutions to solve critical business EDI needs
Assist with the development, testing, implementation, and ongoing maintenance of the HIPAA X12 837 claims, 835 remittance, 834 eligibility, 999 response and other EDI files.
Provide support to all EDI related production processes and develop and modify all EDI maps for trading partners
Assist with the design and maintenance of all EDI maps to ensure compliance to all business requirements and analyze all EDI implementations and recommend improvements to processes and coordinate and communicate with all trading partners to resolve all reported issues effectively
Run and upload HIPAA claims and eligibility files from and to various trading partners based on a corporate schedule
Process rejection reports associated with daily remittance files, correct rejected transactions, and resubmit the transaction. Work with trading partners to resolve any operational issues
Support day-to-day operations of multiple HIPAA X12 EDI transactions, including EDI mapping for 834, 837, 270, 277CA, 275, 276, 278, and identifying any technical problems with sending/receiving these transactions.
Execute SQL (structured query Language) scripting to store, extract and manipulate data from relational database interfaces
Research and review electronic data received from providers/vendors to ensure presence and accuracy of critical X12 EDI data elements
Support the configuration and mapping of EDI and other transactional datasets utilizing provided systems and tools
Review system setup and processes on an on-going basis to ensure accurate and optimum setup for data processing
Research all EDI questions and investigate errors and problems in timely manner; tracking issues and follow up with the appropriate inner-departmental teams or external providers or vendors as needed
Provide technical support for healthcare electronic data interchange applications
Collaborate with Internal Staff
Work collaboratively with internal departments to ensure the HIPAA transactions are provided to the trading partners timely and all reported failed records are corrected and resubmitted by the trading partner
Collaborate with LME/MCO staff to assist in determining future technology needs as it relates to EDI files
Provide business systems support in response to user input
Respond to inquiries regarding EDI issues with enrollment, claims, payments, and/or clearinghouse activities
Conduct analysis of EDI transactions
Develop and Maintain Documentation and Tracking
Document, track, monitor and escalate support requests to ensure a timely resolution
Develop EDI Companion Guides working with Trading Partners to meet these standards
Monitor and documents all EDI requests and track all applications and participate in necessary IT and claims meetings
Document all EDI solutions for system development life cycle and maintain all documents specifications and develop various transaction specifications as per requirement
Ensure Continuous Quality Improvement
Analyze the present business practices and processes and find ways to improve them through a continuous performance improvement plan
Works with outside agencies to increase knowledge and share information as needed to provide the best possible solutions to end users
Reporting
Create reports based on Client Services and other department requests
Address Technical Issues
Respond to email, phone calls and support requests tickets from employees and customers seeking help with software or computer related issues
Interface with providers, vendors, and internal departments to provide first level support and to address technical and procedural issues related to EDI
Contact Software providers as needed
Minimum Requirements
Education & Experience
Required:
Graduation from a Community College or Technical School with a two-year degree in an information technology, data science, business administration, healthcare administration or related field and five (5) years of EDI business analyst or related experience that includes managing projects and complex software applications.
Military training and education in the field of work related to the position's role may be substituted on a year-for-year basis.
Preferred:
Bachelor’s degree from accredited university in an information technology or related field and three (3) years of EDI business analyst experience that includes managing projects and complex software applications.
Previous experience with a focus on HIPAA transactions in a healthcare agency
Knowledge, Skills, & Abilities
Comprehensive knowledge of EDI applications system configuration
Specialized knowledge EDI Transaction sets
Thorough knowledge of EDI HIPAA files and experience in developing and maintaining EDI file mappings.
General EDI healthcare transaction set knowledge
Excellent knowledge and understanding of databases and database queries using SQL, Crystal Reports or other query tools
Knowledge of and experience with utilizing desktop business applications, particularly MS Word, MS Excel, MS Project, MS Access
Organizational and problem-solving skills
Excellent communication skills and the ability to address diverse groups of internal and external personnel
Ability to establish and maintain effective working relationships with technical staff and other staff
Ability to follow oral and written instructions and work without constant supervision
Ability to interview users and translate needs to application solutions
Ability to solve problems; ability to manage several projects at the same time
Ability to prepare technical reports and manuals
General knowledge of Managed Care operations
Salary Range
$79,488 - $101,347/Annually
Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity.
An excellent fringe benefit package accompanies the salary, which includes: • Medical, Dental, Vision, Life, Long Term Disability • Generous retirement savings plan • Flexible work schedules including hybrid/remote options • Paid time off including vacation, sick leave, holiday, management leave • Dress flexibility
Education
Preferred
Bachelors or better in Information Technology
Technical/other training or better in Information Technology