EDI Operations Analyst

The EDI Operations Analyst analyzes and improves existing EDI System, strategically plans and provides technical requirements and analysis to various teams and management for improving EDI System. Additionally, this functional position will foster improved processes and return revenue by analyzing existing and establishing new EDI business relationships with payers, clearinghouses, and other network vendors to streamline EDI transaction routing and minimize third party dependency. 

OBJECTIVES

  • Improve EDI system by automating tasks and expand the capabilities by continually including new/learned dynamic abilities in order to support and integrate variety of vendors in our EDI System as a stand alone clearinghouse
  • Monitor and maintain EDI Systems for optimum performance
  • Research and resolve high level EDI Support Issues
  • Conduct research related to new line of business related to EDI
  • Establish business relations with clearinghouse and jurisdiction/contractors
  • Perform EDI release activities

 

 RESPONSIBILITIES

  • Manage ongoing efforts to establish direct relationships with all available payers for Nuesoft EDI business lines that include: Eclaims, ERA, Eligibility, Claim Status Inquiry, e-Statement, e-attachment, and Print Claim
  • Interact with payers, clearinghouses, and third party vendors 
  • Completion of Trading Partner and Business Association Agreements through coordinated efforts with Legal Group, as needed
  • Monitor testing procedures for respective buesiness lines
  • Coordinate efforts to convert payers and providers (e.g. seamless EDI setups and re-enrollments)
  • Build and maintain hardware such as servers
  • Release windows/IIS service including create certificate
  • Release various software releases
  • Analyze the given requirements or issue
  • Monitor the transaction processing systems
  • Automate various EDI services/processes
  • Clear any failed transactions by utilizing various tools
  • Oversee the technical efforts associated with implementations
  • Perform Systems Operations and Maintenance tasks
  • Systems Support concerning EDI systems

 

QUALIFICATIONS 

  • Understanding of ASC X12 [ANSI] format standards in healthcare insurance (837, 835, 270/271, 276/277, 999, 277CA, etc) and ANSI 5010 TR3s
  • ​Understanding and working knowledge of HIPAA EDI protocols
  • Understanding of XML, Web Services, Windows Services, Communication Protocol such as Modem, FTP, FTPS, and HTTPS
  • Understanding of Windows Operating System and Server, Networking, Database Server
  • Understanding of Office, MSSQL, and Postgres
  • Expert analytical skills, ability to plan and organize efforts effectively, effective coordination with other teams
  • Excellent written and oral communication skills
  • Bachelor's degree and relevant experience in the healthcare industry and database/IT