Avispa · 10 hours ago

EDI Analyst - Healthcare

United States

Full-time

Remote

Mid, Senior Level

$55/hr - $55/hr

5+ years exp

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Responsibilities

Maintain and run processes/jobs for electronic claims and other EDI transactions which include:

Working with external trading partners, transferring data through secure channels, loading the data to the production environment, and testing files from new providers/trading partners.

Qualification

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CMS processesClaims managementSQLEncounter strategyClaims payment methodologiesAdjudication processingFederal encounter regulationsSSIS packageEncounter regulatory reportingMS OfficeCompliance requirements

Required

5+ years of experience with CMS processes in a medicare or managed care environment managing claims or encounters.

Bachelor’s Degree in Business Administration, Information Systems, Health Care or other related field, or a combination of equivalent education, training and experience.

Extensive experience with claims encounter strategy and processes.

Strong understanding of how claims payment methodologies, adjudication processing and federal encounter regulations interrelate to maintain compliant encounter reconciliation processes.

Advanced knowledge of SQL, SSIS package, window based computer environment including MS Office and related programs.

Knowledge of encounter regulatory reporting and compliance requirements.