Systems Analyst - EDI; Remote

LOCATION: Remote - This is a home based, virtual position that operates Monday - Friday from 8:30am-5:00pm EST. Vaya Health welcomes applications from NC, SC, GA, TN, VA, MD, and FL.

GENERAL STATEMENT OF JOB

The Systems Analyst-EDI collaborates with business stakeholders and technical staff to bridge the gap between business and technology needs. This role will be responsible for analyzing documentation (including but not limited to Encounter Data Submission Guide, Companion Guides (837I, 837P, 820, /271, 276/277, etc.), NCMT_ Health Plan Billing Guidance, HIPAA Standardized Billing Guide, and North Carolina specific requirements), documenting changes and maintain business systems for the organization.

This position will collaborate with Product Managers, Business Analysts and other project team members to ensure speed of delivery and quality of product is consistent with Vaya Health strategies and objectives. Results-driven and strives to make process and system improvements to support the business community and the organization's goals.

Tasks to include the following:

• Provides analysis and support to customers on EDI-related issues.
• Process daily outbound eligibility (834) files: this includes file generation and retrieval, upload to eligibility system, error resolution.
• Process weekly Encounter and claims (837I and 837P) files: this includes files generation and retrieval, creation of certification reports and error reports for the Encounters team, creation and upload of claims submission batch loaders.
• Upload pass-through files for delegated vendors as determined by contract.
• Generate Certification reports for Vaya and delegated vendor files as determined by contract.
• Respond professionally to written and verbal inquiries from clients, administrators, and both technical and non-technical coworkers about file status, data formatting, etc.
• Identify and coordinate potential process improvements for EDI, including those necessitated by HIPAA and other regulatory entities
• Configure and update claims validation software as needed and troubleshooting errors in processing.
• Create and generate specialized reports for programs as identified.
• Collaborate with IT staff and end-users to resolve issues and improve processes
• Data manipulation and troubleshooting of all types of data files as needed
• Gather, document, and test client requirements against system output
• Participates in design and review of new applications and integration strategies of EDI systems.
• Implementation of new clients using established protocols and resources; participate in meetings to support implementation process
• Implementation of new provider enrollments for EDI file processing.
• Perform data audits and quality control measures.
• Perform other duties as assigned and deemed appropriate by management

ESSENTIAL JOB FUNCTIONS

Analysis and Design:

• Analyze, facilitate, model, and organize information in order to reconcile conflicts, elicit requirements and distinguish solution ideas from business needs.
• Analyze changes of product design to determine the effect on the end-product and impact to business value.
• Ensure technical and non-technical documentation stays consistent with system configuration as changes are made.
• Partner with both internal and external users, business and technical stakeholders to identify and document requirements, functional, non-functional, technical design and processes that support overall business goals and objectives.
• Liaison between business stakeholders (management, customers, or end users) and the software vendors or other Information Technology teams.
• Partner with stakeholders to achieve project goals and provide continued best practice support to ensure successful adoption of the applications/features.
• Thoroughly troubleshoot Tier 2 and 3 support issues for a quick resolution with or without vendor interaction and resolution documentation
• Works under minimal supervision on complex projects to complete deliverables on time
• Translate business requirements into user stories and/or functional/non-functional specifications using mockups/prototypes, process models/diagrams, data models and other documentation where applicable to improve the flow of information through an organization to enhance project success.
• Work with Finance leadership to understand Financial Reporting requirements as they relate to Benefits.

System Configuration and Testing:

• Manage the set-up and configuration of systems
• Develop and implement maintenance procedures, monitor systems health, gather system statistics, and troubleshoot reported errors and alerts
• Perform design, implementation, and upgrades of information systems to meet the business and user needs
• Partner with Quality Assurance team members to ensure the requested requirements are met and work stays on track.
• Evaluate and ensure data integrity of new system enhancements

Administration:

• Participate in business portfolio management meetings - includes report preparation for the meeting and working with stakeholders to…