System Operations Analyst

South Florida Community Care Network LLC•Sunrise, FL

1d•$50,000 - $55,000•Hybrid

About The Position

The System Operations Analyst (SOA) oversees day-to-day Electronic Data Interchange (EDI) operations, ensuring the smooth flow of electronic transactions between the organization and external partners. The role monitors, troubleshoots, and optimizes EDI processes to improve operational efficiency and support the organization’s mission of positively impacting community health and wellness. The analyst processes and validates electronic data in the EPIC Tapestry system, supports timely and accurate data loads, monitors requests, and follows established workflows and procedures. The position requires protecting confidential business information and ensuring applicable processes comply with HIPAA regulations. Community Care Plan currently follows a hybrid work schedule and reserves the right to change schedules based on company needs. The role may involve work inside and outside the office, travel to other offices, and domestic travel. Selected candidates must complete a Level 2 background screening through Florida’s Care Provider Background Screening Clearinghouse.

Requirements

Associate degree preferred and/or two to four years of experience.
Knowledge of the healthcare environment is desired.
Proficiency with relevant computer applications, including MS Word, MS Excel, MS PowerPoint, and Epic.
Accurate keyboarding and the ability to enter data at the required speed, with knowledge of correct spelling, grammar, and punctuation.
Strong computer skills and experience working with databases.
Excellent written and verbal communication skills for gathering business requirements and presenting report data.
Strong organization, time management, and prioritization skills, with the ability to support multiple initiatives accurately in a fast-paced environment.
Action- and results-oriented team player with strong attention to detail and the ability to articulate results.
Good presentation skills and effective oral and written communication practices.
Ability to ensure processes comply with HIPAA regulations.
Ability to complete a Level 2 background screening through the Florida Care Provider Background Screening Clearinghouse if selected.

Nice To Haves

Associate degree.
Knowledge of the healthcare environment.

Responsibilities

Process inbound and outbound EDI feeds, including eligibility, claims, maximum out-of-pocket, health plan employer data, and other required files.
Compile and sort source data, establish data-entry priorities, and enter information into the EPIC Tapestry system.
Identify data integrity issues after manual or automated uploads and create or execute reports for resolution by the team leader or manager.
Assist with loading EPIC files, including Claims, Encounters, MOOP, Eligibility, 835, and 837 files.
Test claim, eligibility, and MOOP loads, as well as the AP claim payment process.
Review workflow and standard operating procedure documents for deficiencies; resolve discrepancies using standard procedures or return incomplete documents for resolution.
Ensure EPIC Tapestry data loads are completed accurately and on time to support timely claims payment.
Validate critical provider business data using industry-specific websites, databases, and internal documents when necessary.
Maintain data-entry requirements by following defined techniques and procedures.
Monitor CRM requests and update system data according to established guidelines.
Follow workflows and policies and procedures while completing daily responsibilities.
Meet assigned project deadlines and goals.
Protect confidential business information.
Perform other job-related duties assigned by a supervisor or management.