EDI Solutions Analyst - Remote

UnitedHealth Group • Eden Prairie, MN

5d • $72,800 - $130,000 • Remote

About The Position

Optum is seeking an EDI Solutions Analyst to join their team. This role focuses on ensuring seamless technical integration between the Medical Management system (MMS) and various Claims systems using the HIPAA X12 EDI 278 Authorization transaction. The analyst will lead trading partner integrations from end to end, working with proprietary systems and connecting them to claims systems like FACETS, IDX, Xcelys, and IKA. The technical environment includes an Azure cloud-based database solution, PostGres SQL, and Snowflake SQL for data analysis and troubleshooting. The role requires strong SQL skills for data mapping and a deep understanding of the X12 278 transaction, including its implementation guide and real-world scenario variances. This is a remote position within the U.S.

Requirements

• 2+ years of experience in the healthcare data environment (eligibility, provider, claims, etc.)
• 2+ years of experience with data mapping and workflow documentation
• 2+ years of Healthcare EDI transaction knowledge and expertise
• 2+ years of Specific EDI X12 ANSI 278 transaction expertise
• 2+ years of EDI 278 Production Support and Maintenance
• 2+ years of experience including editing and correcting X12 278N transactions for resubmission to Trading Partners
• 2+ years of EDI testing and validation experience
• 2+ years of Healthcare IT experience
• Experience with SQL (manipulating data and queries) - Relational databases like MySQL, MS SQL, DB2
• Experience using Microsoft Word (creating and editing documents), Microsoft Outlook (email and calendar), Microsoft Excel (pivot tables, formulas (vlookup, xlookup, match, etc..)) and Microsoft Visio (process/data flow diagrams) and Microsoft Teams
• Proven ability to multi task in a very intensive Email, Teams Chat, Service Now Ticketing System and Meeting environment while continuously managing EDI 278 transaction maintenance and support
• Proven ability to keep all company sensitive documents secure (if applicable)
• Dedicated work area established that is separated from other living areas and provides information privacy
• Live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service with very minimal disruptions in service

Nice To Haves

• 2+ years of EDI 278 transaction mapping experience
• Experience working with cloud-based solutions and services
• Knowledgeable about claims billing practices and process management concepts - this may include knowledge of CPT coding or reimbursement processes, 3rd party provider enrollments, claims submissions, EDI 278 and HIPAA transactions and/or accounts receivables
• Proven ability to write clear technical and functional specs for authorization data integration services
• Solid organization skills and attention to detail
• Excellent communication skills, both verbal and written, with the ability to interact with various levels of resources internally and externally

Responsibilities

• Monitor Daily EDI Transaction Processing
• Troubleshoot and Resolve any EDI processing issues
• Implementation Team Resource for EDI validation and Testing as required
• Prepare and update program documentation, job aides, and other artifacts as requested
• Process review, data analysis and measurement for various programs related to prior authorizations, claims and member eligibility
• Preparation of reports as needed by management
• Identification and communication of processing issues to leadership
• May involve some interfacing with clients, managed care customers, IT resources and others when needed
• Assignment of special projects as needed

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed