UnitedHealth Group-posted 4 months ago
$71,200 - $127,200/Yr
Full-time • Entry Level
Onsite • Eden Prairie, MN
Insurance Carriers and Related Activities

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. Have you been working with Utilization Management systems and/or Claims Payment systems and their associated HIPAA X12 EDI 278 Authorization transactions? Are you looking for an opportunity to expand your experience working with EDI 278 integrations in the health care industry? We have a great opportunity for an individual to lead trading partner integrations from end to end working with our proprietary Medical Management system (MMS) and connecting it to a variety of Claims systems (FACETS, IDX, Xcelys and IKA, just to name a few). The EDI Solutions Analyst ensures that the technical integration between the MMS and Claims systems is seamless to our end users for all Authorization Data using an EDI 278 transaction. Our technical environment includes an Azure cloud-based database solution where we talk to a PostGres SQL databases for our core application database technology along with leveraging Snowflake SQL to interact with our reporting data warehouse for conducting EDI 278 statistical analysis on the health of our EDI 278 integrations as well as conducting deep dive transaction research for troubleshooting integration issues. You will use your existing database SQL skills to broaden your understanding of the required data mapping necessary to stand up the EDI 278 transaction for our trading partners. Can you articulate and interpret business requirements and compare them against the industry standard technical implementation guide of the X12 278 transaction giving trading partners real-world scenario variances of the allowed usage for the specific loop-segment-element of the EDI 278 transaction? If this sounds like what you have been doing and something you want to continue to build upon your existing in-depth knowledge of how the EDI 278 (Authorization/Referral) transaction works in health care, please read on and apply as we have an opening on our team and would like to hear from you about your existing specialized experience in this space.

  • 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
  • 2+ years of experience in each of the following:
  • Experience within the healthcare data environment - eligibility, provider, claims, etc
  • Experience with data mapping and workflow documentation
  • EDI Production Support and Maintenance experience including editing and correcting X12 278N transactions for resubmission to Trading Partners.
  • EDI testing and validation experience
  • 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)
  • Healthcare EDI Transaction Knowledge and Expertise
  • Specific EDI X12 ANSI 278 Transaction Expertise
  • 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
  • Demonstrated ability to write clear technical and functional specs for authorization data integration services
  • Comprehensive benefits package
  • Incentive and recognition programs
  • Equity stock purchase
  • 401k contribution
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