Systems Analyst - EDI (Remote)

Vaya Health

1d•Remote

About The Position

The Systems Analyst-EDI collaborates with business stakeholders and technical staff to bridge the gap between business and technology needs. This role will be responsible for analyzing documentation (including but not limited to Encounter Data Submission Guide, Companion Guides (837I, 837P, 820, 835,834,270/271, 276/277, etc.), NCMT_ Health Plan Billing Guidance, HIPAA Standardized Billing Guide, and North Carolina specific requirements), documenting changes and maintain business systems for the organization. This position will collaborate with Product Managers, Business Analysts and other project team members to ensure speed of delivery and quality of product is consistent with Vaya Health strategies and objectives. Results-driven and strives to make process and system improvements to support the business community and the organization’s goals.

Requirements

Ability to work with multiple levels of an organization through functional boundaries.
Knowledge of relevant technology concepts (e.g. relational databases, XML, SQL, Powershell, Azure Services).
Knowledge of Business Intelligence concepts (e.g. reporting, querying software, OLAP, spreadsheets, dashboards, and data mining).
Experience with PowerShell, XML/XSLT, SQL Server and other database technologies
Possess strong written and verbal communication skills, including prioritizing, problem solving and interpersonal relationship building.
Experience with common software development lifecycle methodologies, including Waterfall and Agile models (Agile strongly preferred).
Ability to establish and maintain effective working relationships with a service-oriented attitude in a fast-paced team environment. Includes interaction with internal staff as well as customer staff members and the ability to effectively convey computing concepts to non-technical staff.
Ability to make suggestions for process improvement to ensure efficiency in IT and Business processes.
Ability to work under pressure and get the job done with attention to detail and within deadlines.
Ability to demonstrate a high level of accountability and integrity.
Ability to conduct software presentations for business stakeholders and technology teams.
Ability to adapt to the business ecosystem and develop a thorough understanding of the technology environment.
Proficient at analyzing complex inputs and translating data into well-defined system requirements.
Experienced at creating and maintaining accurate detailed documentation which can be understood by staff or customers at any level.
Proven time management and organization skills to prioritize workload and meet deadlines.
Experience on at least one enterprise and cross-functional projects or with integration of multiple systems on dissimilar platforms a plus.
Ability to create diagrams, workflows, use cases, user stories and test cases.
Ability to accurately estimate work effort and plan work to meet deadlines
Self-motivated with the ability to handle multiple tasks simultaneously
Excellent knowledge in MS Word, MS Excel, MS Visio or equivalent software
High School Diploma and ten (10) years of experience supporting business computer systems or similar applications
Associate Degree and four (4) years of experience supporting business computer systems or similar applications
Bachelor’s Degree and 2-5 years of related experience analyzing and designing business systems

Responsibilities

Provides analysis and support to customers on EDI-related issues.
Process daily outbound eligibility (834) files: this includes file generation and retrieval, upload to eligibility system, error resolution.
Process weekly Encounter and claims (837I and 837P) files: this includes files generation and retrieval, creation of certification reports and error reports for the Encounters team, creation and upload of claims submission batch loaders.
Upload pass-through files for delegated vendors as determined by contract.
Generate Certification reports for Vaya and delegated vendor files as determined by contract.
Respond professionally to written and verbal inquiries from clients, administrators, and both technical and non-technical coworkers about file status, data formatting, etc.
Identify and coordinate potential process improvements for EDI, including those necessitated by HIPAA and other regulatory entities
Configure and update claims validation software as needed and troubleshooting errors in processing.
Create and generate specialized reports for programs as identified.
Collaborate with IT staff and end-users to resolve issues and improve processes
Data manipulation and troubleshooting of all types of data files as needed
Gather, document, and test client requirements against system output
Participates in design and review of new applications and integration strategies of EDI systems.
Implementation of new clients using established protocols and resources; participate in meetings to support implementation process
Implementation of new provider enrollments for EDI file processing.
Perform data audits and quality control measures.
Perform other duties as assigned and deemed appropriate by management
Analyze, facilitate, model, and organize information in order to reconcile conflicts, elicit requirements and distinguish solution ideas from business needs.
Analyze changes of product design to determine the effect on the end-product and impact to business value.
Ensure technical and non-technical documentation stays consistent with system configuration as changes are made.
Partner with both internal and external users, business and technical stakeholders to identify and document requirements, functional, non-functional, technical design and processes that support overall business goals and objectives.
Liaison between business stakeholders (management, customers, or end users) and the software vendors or other Information Technology teams.
Partner with stakeholders to achieve project goals and provide continued best practice support to ensure successful adoption of the applications/features.
Thoroughly troubleshoot Tier 2 and 3 support issues for a quick resolution with or without vendor interaction and resolution documentation
Works under minimal supervision on complex projects to complete deliverables on time
Translate business requirements into user stories and/or functional/non-functional specifications using mockups/prototypes, process models/diagrams, data models and other documentation where applicable to improve the flow of information through an organization to enhance project success.
Work with Finance leadership to understand Financial Reporting requirements as they relate to Benefits.
Manage the set-up and configuration of systems
Develop and implement maintenance procedures, monitor systems health, gather system statistics, and troubleshoot reported errors and alerts
Perform design, implementation, and upgrades of information systems to meet the business and user needs
Partner with Quality Assurance team members to ensure the requested requirements are met and work stays on track.
Evaluate and ensure data integrity of new system enhancements
Participate in business portfolio management meetings - includes report preparation for the meeting and working with stakeholders to prioritize requests in the portfolio.
Monitor ticket queues to ensure new issues are addressed in a timely manner.
Participate in troubleshooting to Level 1 support of Enterprise applications
Demonstrate excellent verbal and written communications skills with technical and non-technical clients Mediates between end users and software vendor as the point of contact and an advocate for the business
Work with the Technical Writers to maintain Standard Operating Procedure (SOP) documentation used to manage, configure, and/or maintain each application.