EDI Analyst

Wellmark•Des Moines, IA

About The Position

Responsible for implementing tactics to achieve Electronic Data Interchange (EDI) strategies by working with multiple business areas and other IT professionals to document requirements, develop, test and implement electronic transactions with business partners. Support ongoing maintenance of these transactions and troubleshoot and resolve issues that arise. Maintain and support electronic transactions and/or applications by possessing knowledge of the organization's systems, business processes, as well as current technology advances and IT capabilities. Responsible for building and maintaining relationships with payer and clearinghouses/submitters. Responsible for researching claims discrepancy issues and producing claims reconciliation reports between clearing houses/submitters and Wellmark technology systems.

Requirements

Bachelor’s Degree or direct and applicable work experience
Minimum of 1+ years’ experience in technical business analysis
Experience with electronic eligibility, claim status, billing, pre-authorizations, claims and payment remittance transactions
Experience with ANSI X.12 compliant EDI transactions, including 820, 270/271, 276/277, 278, 834, 837 & 835s
General knowledge of programming and software development processes
Knowledge of system development life cycle methodologies, including testing coordination
Knowledge and understanding of business dynamics
Knowledge of high level project management methodologies
Strong communication and listening skills
Ability to ask questions to understand others’ issues
Ability to build and maintain relationships based on trust
Ability to see a task through to completion independently and as a team member
Strong analytical problem solving skills; break problems apart systematically to understand the root cause
Ability to organize time and priorities to achieve business results
Ability to make decisions aligned with Wellmark policies, systems, and processes

Responsibilities

Ensure EDI implementation projects are analyzed, planned, developed, compliant, tested and completed.
Create test transactions, run tests, find errors and confirm business requirements are met. Capture testing results in a test plan that compares expected to actual results.
Participate in industry workgroups to help define the implementation of ANSI X12 transactions and ensure Wellmark’s compliance with the HIPAA X12 guidelines.
Support and adhere to Wellmark’s software development lifecycle (SDLC), operational and development procedures, and security standards.
Assist other Technology EDI staff in determining best practices for business process improvement to positively impact level of service.
Collaborate with EDI team and Electronic Commerce (EC) Solutions to understand and set direction for EDI transactions.
Manage the day-to-day EDI relationships between Wellmark and submitters.
Provide assistance to project managers in project administrative tasks, including project reporting and documentation.
Identify and report deliverable status and/or issues to project manager and leader. Communicate accurately and concisely in a forum appropriate to the audience.
Establish and build working relationships with IT and business teams. Actively listen to others’ ideas; share information and ideas to help team reach goals.
Provide exceptional service for our stakeholders ensuring timely and accurate results.
May organize EDI marketing efforts with submitters.
Other duties as assigned.