EDI Analyst/Manager

Job Description

An Employer in the Mason, OH area is seeking a Sr. EDI Manager for a hybrid three day onsite contract to hire opportunity. The ideal candidate will play a critical role within the Business Data Solutions team to maintain and implement Medicaid encounter feeds. This role will be the primary resource implementing new client and/or state outbound transactions. You will develop requirements based on stakeholder meetings and interpretation of Companion Guides. You will identify, recommend and implement process improvements in support of the EDI system based on observation, monitoring and external inquiries regarding EDI issues. They will also be responsible for researching and analyzing encounter edits or rejections for Medicaid clients and work with internal/external teams to resolve. They will work to improve overall encounter, member and provider data quality. As well as tracking encounter submission quality and timeliness.

Maintain compliance to all company and regulatory policies

Provide support during and after implementation for HIPAA claims-based EDI transactions

Respond to inquiries regarding EDI issues with encounter claims and trading partner activities

Ensures all outbound 837 transactions return appropriate responses (999, 277CA, custom)

Develop standard and custom testing plans to ensure compliance with requirements

Develop and execute test scripts related to EDI transactions

Conducts QA and testing on EDI applications

Management of catalog of EDI Companion Guides such as 837, 999, 277CA, 835

Maintain detailed documentation and process flow of all EDI processes

Research and analyze Encounter Edits or Rejections to identify trends and root cause

Collaborate with other departments to research, identify and correct data errors to minimize ongoing rejection risk

We are a company committed to creating inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity employer that believes everyone matters. Qualified candidates will receive consideration for employment opportunities without regard to race, religion, sex, age, marital status, national origin, sexual orientation, citizenship status, disability, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to . The EEOC "Know Your Rights" Poster is available here .

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Skills and Requirements

5+ years of experience with EDI mapping for 837

4+ years of Medicaid and Insurance Claims processing experience - must have done multiple configurations and implementations for various states

5+ years of experience in data feeds/transactions

SQL - basic understanding

Data analysis and troubleshooting HIPAA X12 EDI Transactions experience

Experience with EDI mapping for 837, 999, 277CA, 835

GlobalScape/Secured File Transfer Protocol (SFTP)

Trizetto Facets

SAP BusinessObjects Web Intelligence null

We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal employment opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment without regard to race, color, ethnicity, religion,sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military oruniformed service member status, or any other status or characteristic protected by applicable laws, regulations, andordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or the recruiting process, please send a request to .