EDI Analyst

Responsibilities

The primary responsibilities of the role include but are not limited to :

Responsible for integrating any new vendor relationship using Electronic Data Interchange and file layouts for eligibility, accumulator, claim detail, and other files.

Examples of such files include flat file in delimited or fixed width .txt, .xlsx, .csv, 834 files, or new file layouts.

• Build and maintain relationships with carriers; serve as liaison to bridge gaps between system partners and internal outward-facing staff.
• Documenting the scope of work in all stages of integration, noting customizations, routing rules, data mapping, etc.
• Obtain EDI file specifications, File encryption, and transmission information from carrier
• Develop mapping and translations between data elements for file feeds.
• Develop EDI files from the HRIS system to carrier.
• Coordinate and test EDI feeds with external carriers
• Establish and set up file transfer protocols or other various means of connection with outside carries
• Manage receipt and delivery of test files; advise Benefit team of any issues with adjudication system test files. Work with the Carrier if there are any issues with vendor test files
• Partner with Benefits Operations setups of new client set up and other relevant matters surrounding the implementation
• Set up FTP, web folders, etc. as needed.
• Support with any and all production EDI issues.
• Maintain awareness of and ensure adherence to standards regarding privacy.

Qualifications :

• Has solid technical understanding of EDI files (fixed length, delimited, XML) and adjudication system requirements
• Computer proficiency and technical aptitude with the ability to utilize various connectivity solutions (FTP / Secure FTP, Webfolders (WebDAV), VPN), and use of MS Office applications.
• Works on assignments that are complex in nature in which judgment and initiative are required in resolving problems and making recommendations
• Thorough knowledge of company and departmental policies and procedures.
• Abide by all obligations under HIPAA related to Protected Health Information (PHI).
• Attend, complete, and demonstrate competency in all required HIPAA Training offered by the company.
• Flexibility to understand, appreciate and embrace that this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee.

Duties, responsibilities and activities may change, or new ones may be assigned at any time with or without notice.

• Must understand relational database concepts, table design and structure, joins, data normalization, and data types.
• Experience with SQL is required.
• 2-4 or more years’ experience in a healthcare delivery or healthcare business setting preferred.
• Strong communication skills both written and verbal.

Compensation and Perks :

• Competitive salary.
• Robust employee benefits package including major medical (currently 80% Employer covered for employee and approximately 56-66% Employer covered for dependents depending upon which Cigna plan you choose), dental, vision, long-term disability (100% employer covered), supplemental plans, HSA, FSA, pet insurance, legal discount plan, and more.
• 401k plan with company match.
• Growth and development opportunities.
• Your holistic wellness matters to us. We have a year-round wellness calendar of events, a corporate wellness coach and personal trainer who manages our wellness program throughout the year, fitness classes, fitness challenges, an employee assistance program for employees and their family members.
• Employee discount program.
• PTO, holidays, birthday and volunteer time off.

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