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TISTA Science and Technology Corporation · 1 month ago

Senior Healthcare HIPAA EDI Data Analyst

United States

Full-time

Remote

Mid, Senior Level

$79K/yr - $92K/yr

5+ years exp

TISTA Science and Technology is seeking a Senior Healthcare HIPAA EDI Data Analyst who will work as a subject matter expert in EDI data and business processes. The role involves providing expertise on data solutions, overseeing EDI transactions, and collaborating with various teams to enhance data-driven solutions in the healthcare domain.

Application Performance ManagementCloud ComputingCloud SecurityCyber SecurityData ManagementData StorageDevOpsEnterprise ApplicationsIT InfrastructureIT Management

No H1B

U.S. Citizen Only

Responsibilities

Provides subject-matter expertise on available data and quantitative solutions

Identifies the best combination of available data, analytical methods, and presentation for analytic solutions

Analyzes business data for actionable intelligence

Evaluates data-centric tasks to determine the appropriate analytic approaches

Coordinates work of data analysts, providing subject-matter expertise and guidance

Performs data-mining, modeling and develop customized algorithms to solve analytical problems with incomplete data sets

Develops proper algorithms in order to establish the desired linkage between the existing data in the warehouse and the new data set

Tracks data lineage of benefits to cost, eligibility and enrollment data, provider to beneficiary, and program to utilization

Collaborates with product management and engineering team to understand needs and devise possible solutions

Keeps up-to-date with latest technology trends

Oversee Comprehensive EDI Transactions: Manage and ensure the smooth execution of all HIPAA-compliant EDI transactions, including: 837: Claims (Institutional, Professional, Dental). 835: Payment and Remittance Advice. 270/271: Eligibility and Benefits Inquiry/Response. 276/277: Claim Status Inquiry/Response. 278: Referrals and Authorizations. 834: Benefit Enrollment. 820: Premium Payments

Optimize Transaction Lifecycles: Analyze the entire EDI transaction lifecycle to identify bottlenecks, errors, and inefficiencies, implementing data-driven solutions to streamline processes and improve performance

Error Resolution and Collaboration: Lead initiatives to address and resolve claim rejections, eligibility errors, and payment discrepancies. Collaborate with providers, payers, and clearinghouses to maintain seamless data exchange and compliance

Technical Expertise: Possess extensive experience with HIPAA-compliant EDI transactions and ASC X12 standards. Leverage proficiency in EDI tools, mapping technologies, and data transformation platforms. Demonstrate strong knowledge of healthcare coding standards, including ICD-10, CPT, HCPCS, and NDC

Advanced Data Analysis: Troubleshoot complex EDI issues using tools such as SQL, mapping software, and integration platforms. Optimize database queries and develop detailed reports to provide actionable insights on EDI data trends and system performance

Leadership and Process Improvement: Act as the primary point of contact for all EDI-related issues, ensuring timely resolution and fostering continuous process enhancements to improve efficiency and compliance

Cross-Functional Collaboration: Partner with IT, compliance, operations, and other stakeholders to design, implement, and refine EDI solutions aligned with organizational objectives

Mentorship and Team Development: Provide mentorship to junior analysts, sharing knowledge and expertise to foster team development and ensure consistency in EDI operations

Qualification

HIPAA-compliant EDI transactionsEDI mapping technologiesHealthcare coding standardsSQLETL/Data WarehousingX12/EDIFACT standardsData-miningProcess improvementMicrosoft Office SuiteAgile delivery programsCross-functional collaboration

Required

5 yrs relevant experience in data-mining, modeling and EDI based transactions

Experience mapping and supporting EDI based transactions i.e., 837, 835, 270/271, 276/277, 278, 834, and 820

Knowledge of EDI, X12/EDIFACT standards and practices, and EDI translators

EDI experience (setup, mapping, testing, processing, troubleshooting)

Proficient in EDI layouts (loops, segments, data elements)

Perform EDI onboarding and testing with applicable third-party providers

Create workflows, process flows, and Manage EDI Maps and Connections

Create project plans, test plans, conduct end to end testing

Translator tool knowledge and experience

Working with SQL Server databases

Experience in ETL/Data Warehousing skills

Experience in SAFe Agile team environment driving stand up, backlog grooming, and iteration planning

Experience in a customer–facing role, including comprehending business needs, solving complex problems, and capturing business requirements to convert them into technical requirements

Experience working on Federal programs that are of high priority, visibility, and public-facing

Experience with Agile delivery programs

Must be able to work quickly with a high degree of accuracy with cross-functional teams

Able to work under minimal supervision, act independently and exercise an expert level of decision-making capability

Demonstrated ability and experience using Microsoft Office Suite including Word, PowerPoint, Excel, Visio, and Access

Bachelor of Science degree

The ability to pass a Moderate Background Investigation (MBI)