Not provided by employer
Lead edi business systems analyst
Position summary: the lead edi business systems analyst reports directly to the director, operations – enrollment services and acts as an advisor, liaison, and problem-solver for all incoming and outgoing electronic member enrollment files and transactionsThe lead will be responsible to provide technical/business support to group customers, vendors, and team members prior to and during the enrollment process to ensure accurate and timely implementation of 834 engagements and filesPosition will use knowledge of existing business practices, systems, procedures, and policies to research and resolve production support issues and will maintain supporting documentation and remediation actionsWill be responsible to initiate or assess enhancement requests to improve member enrollment processing efficiency and quality through activities such as project planning, development of business requirements, and testingThe lead is expected to possess an aptitude to quickly understand work processes and flows in various business systems, analyze areas of improvement and work with colleagues to document processesThe lead will need to produce standard and adhoc enrollment related reporting for customers, management, or internal business teams and will act as a subject matter expert on enrollment transactions within enrollment servicesWill provide training/feedback to enrollment analysts as neededPosition responsibilities:
Monitor inbound and outbound edi files for accuracy and troubleshoot processing errors/fallout and prepare summary of issues for management or clients as needed.
Provides production support for internally developed and vendor developed applications including researching problems and conducting root cause analyses.
Proactively assesses and promotes the use of tools, analytics, and automation to enhance daily operations, quality assurance activities, issue resolution, and promote the use of electronic enrollment transactions to minimize manual processing.
Develop a deep understanding of business rules and leverage that knowledge to improve processes, recommend solutions, enhance team performance, and drive progression of selected initiatives
Partner with it and business stakeholders as well as external trading partners to successfully implement a mix of initiatives ranging from functional enhancements to continuous improvements
Develop and maintain regular communication with vendors, clients, and internal business teams to ensure enrollment services is receiving the necessary membership data, and business intelligence to effectively service members and maintain compliance with client plan documents.
Proactively identifies opportunities for process/system enhancement/improvement and assists with development of cost benefit analysis.
Conduct meetings to gather critical information, share ideas and findings, and effectively communicate insights and plans to stakeholders, cross-functional team members, and management.
Assist in managing projects, developing project plans, and monitoring performance to ensure initiatives are prioritized based on business needs and requirements and deliverables are on track for timely completion of projects
Act as liaison between the business and it, leading the definition of functional requirements, explaining changes to business processes, and continually communicating status to applicable team membersServes as an advisor to the it team regarding the business to ensure the effort meets business needs.
Lead and/or perform user acceptance testing and production business validation testing for assigned projects.
May conduct meetings with select customers to communicate and resolve ongoing member eligibility issues.
May assist in the reconciliation and auditing of membership loaded to claim processing platform to ensure accuracy.
Identify, document, and analyze discrepancies and anomalies within automated data reconciliation jobs.
Deliver ad hoc data extracts, analysis or reporting to internal and external customers or management as requested.
Participates in developing robust training material to onboard new hires and support the ongoing development of existing staff.
Provide training, feedback and mentoring to new and current enrollment staff to ensure understanding of the edi 834 transaction.
Responsible to create or update department p&ps, manuals, job aides, or customer companion guides as needed.
Ability to perform duties with minimal supervisionIncludes ability to act both independently and as part of a project team.
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this jobDuties, responsibilities, and activities may change at any time with or without noticePosition qualifications: required
Ba/bs in healthcare management or related field from an accredited college or universityIn lieu of degree, 7+ years’ experience in enrollment processing
5+ year’s hands on experience supporting and troubleshooting x12 834 hipaa transactions including syntax rules
Skills, knowledge, and abilities:
Problem solving, critical thinking, and process analysis skills
Knowledge of healthcare operations, payer business processes and edi interfaces.
Excellent written, verbal, and presentation skills to convey complex ideas, concepts, and applications.
Experience in data analysis, testing, and implementation
Excellent interpersonal skills, including the ability to work collaboratively across the organization
Experience in managing projects across multiple departments in a fast-paced work environment
Working knowledge of microsoft office suite – word, powerpoint
Intermediate excel knowledge including pivot tables, formulas, vlookup
Medcost provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local lawsThis policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.
Medcost participates in the electronic verification system (e-verify) to electronically verify the work authorization of newly-hired employeesE-verify is an internet-based program that compares information from an employee`s form i-9 to data contained in the federal records of the social security administration and the department of homeland security to confirm employment eligibilityMedcost does not use e-verify to pre-screen job applicants.
Posted 1 day ago