133 IT DEVELOPMENT - EDI Analyst
Alameda, CA

Job Description

At Alameda Alliance for Health (Alliance) we are striving each day to create a healthier community and to improve the quality of life of our members throughout our diverse County. As a part of our mission, we collaborate with our provider partners to address social determinants of health and to deliver high quality, accessible, and affordable health care services.

EDI ANALYST

PURPOSE:

The EDI Analyst will support the team by providing daily technical support for EDI activities, research questions and issue resolution; maintaining implementation companion guides; supporting the development of interfaces; performing data audits to validate information exchanged with the providers; and running reports as needed. The EDI Analyst will facilitate the process of onboarding providers for EDI claims submissions, assisting them with application paperwork, helping them work through testing, answering questions regarding the Alameda Alliance for Health companion guides, and approving providers for claims submissions after successful test cycles have been completed.

Essential Functions and Responsibilities:

Organization expects job performance to be consistent with its vision and mission. Day to day work is focused on these key performance areas. Percentages of time are estimates based upon observation in the position.

1. Develop and maintain trading partner definitions, and handling communications with trading partners for EDI transaction set-up, ongoing maintenance, proactively identifying issues and resolving them. (30% of time)

2. Automate and monitor the EDI transaction processes to ensure that transactions are processed accurately and on schedule, and appropriately follow up on any errors. Audits data to validate information supplied to/from providers/ and trading partners. (20% of time)

3. Responsible for EDI map development, testing, and maintaining EDI transactions. Also, participate in system analysis, design, development, and implementation of EDI activities. . (20% of time)

4. Work with internal teams and 3rd party partners to improve and scale our documentation of EDI processes (15% of time)

5. Participates in the analysis of existing business process and systems recommendations/enhancements to improve business performance and maximize the effectiveness of available technology (15% of time).

6. Other duties as assigned.

QUALIFICATIONS:

Education and Experience.

Bachelor's Degree (technical, business or science degree preferred) plus minimum five years of work experience in managed health care (or equivalents).

Minimum 3 years of progressive experience with EDI, familiarity with .net and SQL.

Interpersonal Skills.

Uses good basic customer service skills and respects others. Communicates well and supports team. Skills used 20% to 50% of time.

Decision-Making Ability.

Work limited by standards and procedures. Adapts to recurring operational situations using formal and informal channels. Unusual situations are reviewed with a manager.

Analytical Ability.

Apply basic business, scientific, or technical principles to routine and moderately complex problems.

Required Mental and Physical Effort.

Concentrates and pays close attention to skilled jobs with frequent interpersonal contact between 20% and 50% of time. Requires adaptability.

Stand or sit, walk, and lift up to 10 pounds.

Management or Supervisory Responsibility.

None.

Environmental Conditions.

Pleasant, well-lighted area with comfortable temperature and without

significant amounts of dust, fumes or odors. Unavoidable accidents and

health hazards are unlikely.

Special Skills/Certifications/Knowledge Required.

Working, in-depth knowledge of ANSI ASC X12 and HIPAA standard formats, especially claims, enrollment, eligibility and claim status inquires, and remittances.

Knowledge of ANSI ASC X12 837 transaction set in version 5010.

Knowledge of medical billing or health care data and data interfaces.

Knowledge and skill set to automate the system to monitor/ report and notify EDI transactions.

Professional verbal and written communication skills.

Ability to effectively correspond with both business and technical staff and translate needs accordingly

Equipment Experience Required:

PC based Microsoft Office Suite, SharePoint, and claim adjudication software interface experience.

HIPAA translation software and testing engines such as EDIFECS or ClarEDI.

Salary Range $89,360 - $134,050/ annually

Alameda Alliance for Health is an EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

Other details

* Pay Type Salary
* 1240 S Loop Rd, Alameda, CA 94502, USA