EDI Analyst

American Vision Partners•Phoenix, AZ

About The Position

The EDI Analyst is responsible for developing, implementing, and maintaining Electronic Data Interchange (EDI) transactions, including HIPAA 270/271 eligibility inquiry and response, 276/277 claims status inquiry and response, and 278 referral/prior authorization transactions. The role works with claims and payment teams on HIPAA 837 health care claims and 835 health care claim payment/advice. It collaborates with information systems staff, government and third-party payers, clearinghouses, and NextGen technical support to implement transactions in an integrated, efficient, and cost-effective manner. The position plans, implements, and manages HIPAA EDI projects, including end-user contact, analysis, design, mapping, programming, training, and documentation. Candidates need revenue cycle management experience. The role is intended for candidates specializing in EDI analytics and ERA/EFT enrollments, not developers or designers. It may be remote in Arizona, Nevada, California, New Mexico, or Texas.

Requirements

At least five years of experience in healthcare revenue cycle management, including payment posting or patient access.
Two to three years of hands-on experience with ANSI X12 healthcare EDI transaction sets, including 837, 999, 277CA, 276/277, and 835.
Hands-on analyst or equivalent role experience with ERA/EFT enrollments.
Prior EDI or system implementation and transaction mapping experience.
Experience with NextGen EHR or other healthcare EHR software.
Proficiency in Microsoft Office, including advanced Excel formulas and pivot tables, PowerPoint, Word, and Outlook, as well as SmartSheet navigation.
High school diploma or GED.

Nice To Haves

Bachelor of Arts or Bachelor of Science in Information Technology, Computer Science, Computer Engineering, or equivalent.
Previous experience using and navigating clearinghouse platforms such as Waystar or Change Healthcare.

Responsibilities

Set up and complete EDI registration for all EDI products, including facilitating payer-specific enrollments until payer approval is granted.
Install and configure healthcare EDI applications on provider networks and/or billing stations.
Research and analyze providers’ billing requirements to ensure data fields are correctly mapped and converted in inbound and outbound X12 ANSI files.
Initiate test EDI transactions before implementation in the live environment, then provide 6 to 8 weeks of post-live support by monitoring EDI product usage and conducting weekly follow-up calls with billing administrators to ensure accuracy.
Customize provider inbound and outbound EDI transactions based on payer-specific edits and requirements received in responses.
Recommend additional resources and features that leverage EDI products and provide efficient solutions for practice operations.
Develop solutions and provide revenue cycle leadership with implementation status updates on a bi-weekly basis.
Serve as liaison between providers and healthcare trading partners regarding EDI inquiries, including enrollment, claims, payments, and clearinghouse interface rejections.
Set up new payer connections, testing, and launches; research new payer requests and submit them to the EDI QA/Development team for programming.
Maintain and update remit address changes with government and commercial payers weekly, monthly, or quarterly.
Manage payer website logins, grant new access, deactivate access, and provide password resets for revenue cycle management teams.
Develop and execute formal testing methodologies and test plans, and document test results.
Perform other assigned duties.