System Operations Analyst

South Florida Community Care Network•Sunrise, FL

11h•Hybrid

About The Position

The System Operations Analyst (SOA) oversees day-to-day Electronic Data Interchange (EDI) operations and ensures 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 to positively impact community health and wellness. The analyst processes and validates electronic data, including eligibility, claims, maximum out-of-pocket, health plan employer data, and other required EDI files. The role also supports file loading and testing in EPIC Tapestry, investigates data integrity issues, maintains accurate system records, monitors CRM requests, and follows established workflows, policies, and procedures. Candidates should have an associate degree preferred and/or two to four years of experience. Healthcare-environment knowledge is desired, along with proficiency in relevant computer applications, including Microsoft Word, Excel, PowerPoint, and Epic. This position currently follows a hybrid work schedule, which may change based on company needs. The work may involve time inside and outside the office and travel to other offices, as well as domestic travel. Candidates selected for the position must complete a Level 2 background screening through the Florida Care Provider Background Screening Clearinghouse.

Requirements

Associate degree preferred and/or two to four years of experience.
Healthcare-environment knowledge desired.
Proficiency with relevant computer applications, including MS Word, MS Excel, MS PowerPoint, and Epic.
Accurate keyboard skills and ability to enter data at the required speed.
Knowledge of correct spelling, grammar, and punctuation.
Strong computer skills and experience working within databases.
Strong written and verbal communication skills to gather business requirements and present report data.
Well-organized, action- and results-oriented team player with exceptional time-management skills and ability to support multiple initiatives simultaneously in a fast-paced environment.
High attention to detail and ability to establish, articulate, and prioritize results.
Presentation skills and solid oral and written communication practices.
Ability to ensure processes comply with HIPPA regulations.
Ability to meet the position’s physical demands, with reasonable accommodations where applicable.
Successful completion of a Level 2 background screening through the Florida Care Provider Background Screening Clearinghouse for candidates selected for the position.

Nice To Haves

Knowledge of the healthcare environment.
Associate degree.

Responsibilities

Process inbound and outbound EDI feeds, including eligibility, claims, maximum out-of-pocket, health plan employer data and information sets, and other required files.
Compile and sort source data, establish entry priorities, and enter data into the EPIC Tapestry system.
Identify data integrity issues after manual or automated uploads and create or execute reports for the team leader or manager to resolve them.
Assist with loading EPIC files, including Claims, Encounters, MOOP, Eligibility, 835, 837, and other files.
Perform test loads for claims, eligibility, and MOOP, 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 data loads are completed accurately and on time in EPIC Tapestry 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 predefined data-program techniques and procedures.
Monitor CRM requests and update system data accurately in accordance with established guidelines.
Follow workflows and established policies and procedures in completing daily responsibilities.
Meet assigned project deadlines and goals.
Protect business operations and the organization by keeping information confidential.
Perform other job-related duties assigned by a supervisor or management.