EDI Analyst

ASM Research

About The Position

Working in partnership with internal teams, The SBE Disputes EDI Analyst will also be responsible for analysis of discrepancies in the SBE payment dispute process for multiple stakeholders and continuous process improvement of the payment dispute process as well as disposition payment casework with accuracy. He/she will be investigating and providing root cause analysis updates, providing solutions, and drafting issuer responses for complex cases.

Requirements

Bachelor’s Degree or equivalent OR 4 years’ relevant experience in lieu of degree.
2 additional years of experience in the health care industry.
Must be a US Citizen

Nice To Haves

1 year of experience with X12 transactions
1 year of experience with federal data or projects (including but not limited to agencies such as CMS, IRS, DOD, VA, SSA or another federal agency)
Knowledge of the Affordable Care Act
Project management experience
Experience with Federal contracts
Experience with premium payment transactions
Experience in reconciliation of enrollment transactions
Experience with Power BI Reports and Dashboards
Experience with Microsoft Office Suite
Experience with SQL queries

Responsibilities

Review, analyze, and disposition Payment cases with 95% plus accuracy monthly.
Must have a positive attitude and be open to providing solutions and improvements.
Ability to work with complex cases and apply critical thinking skills.
Ability and willingness to think outside of the box and determine creative solutions to business needs/requirements.
Proven ability to multi-task while ensuring flexibility to meet deadlines and support team goals.
Monitor deliverables and ensure timely completion of cases assigned.
Prioritizing initiatives based on business needs and requirements.
Work to resolve issues in a timely and accurate manner and escalate as appropriate.
Excellent verbal and written communication skills.
High organizational skills and attention to detail.
Participate in review and delivery of recurring reports including the Semi-Monthly Issuer Report and Dispute Disposition Report (DDR).
Ability to efficiently work on issuer specific requests and provide timely and detailed responses.
Communicate with team leader and management team regarding escalated casework or issuer concerns.
Ability to deliver presentations in a clear, concise, and engaging manner.
Ability to identify and prioritize responsibilities while completing multiple tasks independently.
Effectively answers complex enrollment and payment questions in a clear and concise written and verbal manner.
Works effectively in a team and independently to complete all tasks in a timely manner with minimal oversight.
Review documented training material, including policy and process documents, for review and accuracy.
Handle ambiguity and change, manage priorities and tasks in a changing environment.
Work with the technical and development team to resolve identified issues in a timely manner.
Work closely with technical team and escalate all the front and backend Issues.
Be able to communicate complex scenarios related to Marketplace enrollment records and reconciliation.