Avēsis · 11 hours ago

Sr. EDI Data Analyst

United States

Full-time

Remote

Mid, Senior Level

$61K/yr - $96K/yr

3+ years exp

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Insurance

Hiring Manager

Cathy Barry

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Responsibilities

Engage actively with the Encounter and Implementation teams to understand the steps of the encounter/rejection process for states/clients.

Participate in State/Client Encounter discussions, acting as a subject matter expert and providing input on suggested process improvements.

Accurately interpret and understand State Encounter/Rejection requirements for multiple markets.

Develop and maintain controls over the Encounter processed data and systems.

Oversee the auditing process and monitor exposure and potential penalty risk. Improve process as business dictates.

Resolve escalated issues on behalf of EDI staff; work with internal staff as needed to ensure the resolution of escalated issues related to Encounters/Rejections.

Analyze exception data and correct code errors/issues. Submit accurate and timely Encounter Acceptance Rate Reports.

Identify trends and inefficiencies in procedures, reports, and workflow to support continuous improvement.

Provide feedback to the manager on recommendations for additional training or coaching to foster continued staff development.

Partner with the management team to resolve potential issues and concerns.

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

SQLClaims ProcessingEDI File FormatsMS SQL ServerTransact-SQLCPT CodesHCPCS CodesMicrosoft OfficeCollaborative

Required

Associate degree in Business Administration/or Healthcare related field or 5-7 years of related work experience.

3-5 years of prior job-related experience demonstrating strong analytical capabilities in claims/encounter processing

3-5 years of Strong SQL experience (create multi-level queries, database maintenance – backup and restore, execute stored procedures, interface with other apps using SDK/API)

Strong knowledge of database application and data query protocol (MS SQL Server, Transact-SQL).

3-5 years comprehensive experience claim processing/resolution

2-3 years experience with standard EDI file formats and protocols such as 837P, 837D, 835, 834, 277, 999.

Excellent knowledge ADA, CPT and HCPCS procedures and codes.

Basic knowledge of Microsoft software (Outlook, Excel, and Word).

As this role is a remote role, you are required to maintain internet service that allows you to complete your essential job duties without issue. Rates of 50 Mbps download and 10 Mbps upload while hardwired and not on a VPN are sufficient.