Senior Professional EDI Business Analyst

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Job description

Gainwell Technologies LLC

Job Description

Essential Functions

• Analyzes, models, designs, develops and implements EDI and X12 Transaction Sets for Medicaid sites.

• Assists in planning and designing business processes; assists in formulating recommendations to improve and support business activities

• Assists in analyzing and documenting client's business requirements and processes; communicates these requirements to technical personnel by constructing basic conceptual data and process models, including data dictionaries and volume estimates

• Designs, develops and implements customized functionality to accommodate business processes related to EDI.

• Assists in creating basic test scenarios to be used in testing the business applications in order to verify that client requirements are incorporated into the system design

• Participates in meetings with stakeholders to gather and document requirements and explore potential solutions

• Assists all other groups involved in integration efforts across the practice that involve EDI & Administrator/HPAS Data component.

Knowledge/Skills/Abilities

• In depth knowledge of HIPAA/EDI X healthcare-related transactions including 270-271, 276-277,277CA,277U, 278, 820, 834, 835, 837, 999, and 824

• Knowledge of EDI applications including the EDI Gateway, Edifecs suite of tools, Microsoft Biztalk, Microsoft SQL Server, and other applications in support of EDI processing

• Knowledge of Administrator/HPAS Data component and Connect

• Fluent with commonly used EDI concepts, practices, and procedures within a heath care field

• Medicaid domain knowledge

• Knowledge of industry standard health data code sets such as ICD-9/ICD-10, CPT/HCPCS, revenue codes

• Knowledgeable with regulatory requirements associated with 5010 and ICD-10

• Specific knowledge of claims, enrollment, and /or Authorizations in a Medicaid environment

• Possesses analytical and creative problem-solving skills

• Excellent verbal and written communication skills

• Ability to abide by Gainwell' s policies

• Ability to maintain attendance to support required quality and quantity of work

• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)

• Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers