Senior EDI Solutions Analyst - Remote

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities.

Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

Have you been working with Utilization Management systems and/or Claims Payment systems and their associated HIPAA X12 EDI 278 Authorization transactions? Are you looking for an opportunity to expand your experience working with EDI 278 integrations in the health care industry? We have a great opportunity for an individual to lead trading partner integrations from end to end working with our proprietary Medical Management system (MMS) and connecting it to a variety of Claims systems (FACETS, IDX, Xcelys and IKA, just to name a few).

The Sr. EDI Solutions Analyst ensures that the technical integration between the MMS and Claims systems is seamless to our end users for all Authorization Data using an EDI 278 transaction. Our technical environment includes an Azure cloud-based database solution where we talk to a Post Gres SQL databases for our core application database technology along with leveraging Snowflake SQL to interact with our reporting data warehouse for conducting EDI 278 statistical analysis on the health of our EDI 278 integrations as well as conducting deep dive transaction research for troubleshooting integration issues.

You will use your existing database SQL skills to broaden your understanding of the required data mapping necessary to stand up the EDI 278 transaction for our trading partners. Can you articulate and interpret business requirements and compare them against the industry standard technical implementation guide of the X12 278 transaction giving trading partners real-world scenario variances of the allowed usage for the specific loop-segment-element of the EDI 278 transaction?

If this sounds like what you have been doing and something you want to continue to build upon your existing in-depth knowledge of how the EDI 278 (Authorization/Referral) transaction works in health care, please read on and apply as we have an opening on our team and would like to hear from you about your existing specialized experience in this space.

You'll enjoy the flexibility to work remotely
* from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.

Primary Responsibilities:

* Monitor Daily EDI Transaction Processing

* Troubleshoot and resolve any EDI processing issues

* Implementation Team Resource for EDI Mapping, Validation and Testing as required

* Prepare and update program documentation, job aides, and other artifacts as requested

* Scheduled and ad hoc auditing of various systems and databases to support prior authorization transactions

* Process review, data analysis and measurement for various programs related to prior authorizations, claims and member eligibility

* Create process and data flow diagrams for the various programs/projects as assigned

* Preparation of reports as needed by management

* Identification and communication of processing issues to leadership

* Prepares and coordinates presentations, training, etc; used as an educational resource

* Implementation of new technologies and processes (includes testing and follow up)

* May involve some interfacing with clients, managed care customers, IT resources and others when needed

* Assignment of special projects as needed

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

* 5+ years of experience in each of the following:

* Experience with in the healthcare data environment - eligibility, provider, claims, etc

* Experience with data mapping and workflow documentation.

* Healthcare EDI Transaction Knowledge and Expertise

* Specific EDI X12 ANSI 278 Transaction Expertise

* EDI transaction mapping experience

* EDI Production Support and Maintenance Experience including editing and correcting EDI 278N X12 package data for resubmission.

* EDI testing and validation experience

* Healthcare IT MMS (Medical Management Systems) experience

* Experience with SQL (manipulating data and queries) - Relational databases like MySQL, MS SQL, DB2

* Experience using Microsoft Word (creating and editing documents), Microsoft Outlook (email and calendar), Microsoft Excel (pivot tables, formulas (vlookup, xlookup, match, etc..) and Microsoft Visio…