Lynn, Massachusetts
EDI Systems Analyst Job Opening in Lynn, Massachusetts - GENERAL SUMMARY:
The EDI Systems Analyst is responsible for providing analysis and supporting internal and external customers on complex Electronic Data Interchange issues. Responds to complex inquiries relating to EDI from providers and internal departments.
ESSENTIAL RESPONSIBILITIES:
Develop technical specifications for EDI application interfaces; provide regular testing and technical support during and after implementation of healthcare EDI applications and updated transaction formats.
Respond to regular EDI inquiries and troubleshoot issues from internal organizations, trading partners and vendors regarding healthcare transactions (claims, enrollment, payments, encounter, etc.) and clearinghouse activities.
Conduct various analyses of EDI transactions and formats; handle format mapping and other EDI documentation as well as various EDI reporting.
Provide and communicate local expertise regarding standard concepts, practices and procedures of EDI formats (proprietary, NSF, ANSI, HIPAA).
Research, evaluate and implement vendor partner initiatives and manage end-to-end implementation process (provider , vendor , completing of banking and contractual agreements, provider setup, testing and evaluation).
Audit claims for coding accuracy, benefit payment, contract interpretation and compliance with policies and procedures.
Respond to audit rebuttals.
Exercise discretion and independent judgment with critical analysis, offering solutions and expert advice to management.
Performs other duties as required.
JOB SPECIFICATIONS:
High School Diploma. Associate?s Degree preferred.
1 to 3 years of experience in data analysis in a customer service environment within the healthcare insurance industry.
Intermediate to advanced skills in MS ACCESS.
Demonstrated analytical, problem solving and critical thinking skills.
Experience with industry software for HIPPA pre-production transaction testing
Excellent communication and presentation skills.
Highly self-motivated and able to work well in a fast-paced environment.
Job Type: Full-time
Required education:
Associate
Required experience:
Microsoft Access: 1 year
Data Analysis: 1 year
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