Systems Analyst - EDI; Remote

Overview

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 maintaining 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.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• 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

QUALIFICATIONS

EDUCATION & EXPERIENCE REQUIREMENTS

• High School Diploma and ten (10) years of experience supporting business computer systems or similar applications
• Associate Degree and four (4) years of experience supporting business computer systems or similar applications
• Bachelor's Degree and 2-5 years of related experience analyzing and designing business systems

PHYSICAL REQUIREMENTS

• Close visual acuity to perform activities such as preparation and analysis of documents; viewing a computer terminal; and extensive reading.
• Physical activity in this position includes crouching, reaching, walking, talking, hearing and repetitive motion of hands, wrists and fingers.
• Sedentary work with lifting requirements up to 10 pounds, sitting for extended periods of time.
• Mental concentration is required in all aspects of work.

RESIDENCY REQUIREMENT
:
The person in this role must live in NC, SC, GA, TN, VA, MD, or FL.

SALARY
:
Depending on qualifications & experience of candidate. This position is exempt and is not eligible for overtime compensation.

DEADLINE FOR APPLICATION
:
Open Until Filled.

APPLY
:
Vaya Health accepts online applications in our Career Center, please visit

Vaya Health is an equal opportunity employer.