• Sr. EDI Systems Analyst

    Job Locations US-VA-Richmond
    Job ID
    2018-4938
  • About Us

    Don’t just find a job, find your WHY at a purpose-driven organization; discover a career at Virginia Premier.
    By blending quality benefits, affiliating with the world-renowned VCU Health System and offering career-advancing development programs, we allow our employees to focus on the meaningful work of improving and saving the lives of more than 200,000 people throughout the state of Virginia.
     
    At Virginia Premier, we are building an industry leading health care organization through dedicated teams that have heart, provide top-notch quality member services and embrace our mission of inspiring healthy living within the communities we serve. Our vision is to connect people to innovation, quality and affordable health care for all phases of life.
     
    If this sounds like you, read on!

    Overview

    Electronic Data Interchange Specialist – Level III serves as an EDI subject matter expert and will be responsible for ensuring EDI standards are included in project requirements, design, and development. The position will coordinate and execute the daily EDI support activities to ensure the delivery of technical services and participate in the fulfillment of customers’ requests.  Assigned tasks will include (but are not limited to) trading partner setup and maintenance, research, documentation, and project tasks. This position will also be responsible for development and enhancements to the EDI dashboards, EDI daily reconciliation reports and complex SQL queries for EDI Analytics.  The scope of this role will include management of department projects, solution and enhancement roadmaps, and new lines of business implementations.

    Responsibilities

    • Serve as primary resource supporting all the HIPAA X12 Transactions used in the organization; 837 Claims, 835 Remits, 834 Enrollment, 820 Capitation, 276/277 Claim Status Request and 270/271 Enrollment Inquiry and any other EDI X12 layout.
    • Gain expertise on the use of HL7 for inbound data where X12 formats are not applicable.
    • Support the development of technical EDI documentation, technical reports and companion guides.
    • Lead and participate in projects
    • Analyze and design specifications used for enhancements and modifications to EDI applications, interfaces, and mappings
    • Manage and own relationships with key internal and external stakeholders and partners including direct provider engagement.
    • Ensure operational readiness for new lines of business by planning, recommending, testing, and implementing processes that produce accurate results
    • Keep abreast of changes in the industry as directed by the Workgroup for Electronic Data Interchange (WEDI) and the American National Standards Institute (ANSI)
    • Adhere to change management policies to minimize the impact of changes and represent department in change management meetings.
    • Conduct problem resolution for supported applications.
    • Create complex queries that join multiple tables / sources and significant data extraction.
    • Create test scenarios, create test data, validate test cases and document test results.
    • Develop and design reports
    • Ensure that the proper deadlines and turnaround times are met.
    • Implementation, configuration, testing and post implementation support.
    • Pro-active monitoring, incident management, and escalation of issues related to the monitored business processes.
    • Must be available to work evenings and weekends during server upgrade and system maintenance.
    • Creating and certifying standard operating procedures and manuals
    • Conduct end-to-end business process activities - creating, controlling, mapping, and improving business processes.
    • Effectively facilitate requirements-gathering sessions with end users to perform gap analysis: as is vs. to be, to collect, analyze and document existing and new business requirements, to translate business requirements into a solution design, to create functional and technical requirements documents
    • Work independently while managing multiple tasks and deadlines.
    • Mentor team members.
    • Performs other related duties as assigned.

    Qualifications

    MINIMUM EDUCATION REQUIREMENTS

    • Bachelor’s Degree required, in Computer Science, Business Administration, Information Systems or related field

    SPECIAL KNOWLEDGE AND/OR SKILLS

    • Expertise in the healthcare industry to include key managed care functions such as claims, enrollment, and Medical Management
    • Expertise in ANSI X12 formats such as 835s, 834s and 837s/277s
    • Experience with TSQL, SSMS, SSRS, SSIS, SQL Server data tools, SQL server design studio.
    • Ability to troubleshoot, research, and solve technically challenging problems involving integrated systems.
    • Ability to understand and document processes and issues in user departments.
    • Customize and configure specific applications in response to department needs; install and debug new and/or upgraded software on server and client platforms.
    • Possess excellent leadership, communication and presentation skills with the ability to communicate complex technical concepts to business users in a clear and concise manner
    • Experience in enterprise level monitoring
    • Experience supporting end-users in a corporate environment.
    • ·xperience with SQL and relational database concepts
    • Experience with Microsoft SQL Server 2005 and 2008, SQL Server Integration Services (SSIS), and SQL Server Reporting Services (SSRS).
    • Familiar with ITIL standards
    • Familiarity with key managed care functions including claims, enrollment, and Medical Management.
    • Proficient knowledge of Microsoft Office products
    • Project Management skills
    • Skill in effectively managing and prioritizing multiple projects and tasks to meet deadlines.
    • Skill in resolving customer complaints and concerns.
    • Understanding of Health Care Industry; knowledge and understanding of Protected Health Information (PHI)
    • Strong written and communication skills
    • Windows Operating Systems: Professional 2000, XP, VISTA, Windows 7 & Server 2003 and 2008
    • Experience in supporting end-users in a corporate environment and excellent communication/teamwork skills
    • Knowledge of web technologies, Windows server 2012 and Visual studio
    • Experience with Project Management software
    • Experience with knowledge transfer and documentation of software, policies, and procedures.
    • Strong documentation management and process flow experience

    WORK BACKGROUND/EXPERIENCE

    • Experience with health care based claims administration and processing platforms a plus
    • Minimum of five years working in Electronic Data Interchange field
    • Experience with managed care, Medicaid, and Medicare is a plus
    • Exceptional candidates will have experience with Microsoft BizTalk, QNXT, and IDX
    • 5+ years IT experience as a Business/Systems Analyst
    • 5+ years of experience in application support and troubleshooting.

    PHYSICAL REQUIREMENTS

    • Physical health sufficient to meet the ergonomic standards and demands of the position.

     

    **All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. EOE

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