Pinnacle Technology · 2 hours ago

Electronic Data Interchange Analyst

United States

Contract

Remote

Mid, Senior Level

5+ years exp

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ConsultingInformation Technology

Hiring Manager

Aditya Verma

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Responsibilities

Maintaining and running processes/jobs for electronic claims and other EDI transactions

Working with external trading partners

Transferring data through secure channels

Loading the data to the production environment

Testing files from new providers/trading partners

Qualification

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SQLSSISClaims Encounter strategyCMS processesHealth Care experienceFederal encounter regulationsMS OfficeElectronic claimsRegulatory reporting

Required

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

Minimum of five (5) years’ experience with CMS processes in a Medicare or Managed Care environment managing claims or encounters

Extensive experience with Claims Encounter strategy and processes

Demonstrate 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