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Edi Business Analyst
3 months ago
Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.
This position is remote within the state of AZ only._ This remote work opportunity requires residency, and work to be performed, within the State of Arizona._
- Purpose of the Job
- The role of the EDI Business Analyst is to work with the business and the IT team to ensure the timely and accurate posting of all responses to claim submission, eligibility request, claim status request and remits as well as all outbound files to new and established trading partners ensuring daily balance and controls of all in/outbound data. This individual will work to continuously improve the enterprise processes and procedures to provide the highest value possible for our customers—function as EDI expert assisting and training other EDI Production team members.
- Qualifications
- REQUIRED QUALIFICATIONS
- Required Work Experience
- 8 years of experience in EDI and/or information systems
- 8 years of experience in data analysis, data management and integration, extracting and analysis reporting
- Ability to read EDI transactions
- Knowledge of EDI transactions, 834, 835, 837 and 27X
- Required Education
- High-School Diploma or GED in general field of study
- Required Licenses
- N/A
- Required Certifications
- N/A
- PREFERRED QUALIFICATIONS
- Preferred Work Experience
- 4 years of experience in computer technology and/or information systems
- 8 years of experience working in healthcare-related systems as a business / systems analyst or programmer
- Preferred Education
- Bachelor’s Degree in Computer Science, Information Systems, Business, or related field
- Preferred Licenses
- N/A
- Preferred Certifications
- N/A
- Essential Job Functions and Responsibilities
- Research and address responses from production reports with inbound/outbound trading partners
- Take ownership of file transmission issues and coordinate resolution between business and IT
- Maintains relationship and needs of the business owner for partner integration.
- Translate business needs into data requirements.
- Ability to compare large data sets in excel or other tools for reconciliation.
- Assist in User Acceptance Testing
- Manage production validation tasks as a part of Go Live
- Analyze EDI data to troubleshoot or optimize business processes and needs.
- Maintain a full understanding of all inbound/outbound files for assigned routes
- Analyze response parsing errors and effectively communicate program requirements to IT Trading Partner team
- Pursue better connectivity options for automation, security, and performance
- Ensure inbound/outbound files are are received from trading partner’s FTP/website once available.
- Alert internal teams of any variance in receipt of transactions
- Manage implementation of new direct connections and industry mandates
- Manage current route connections and payer setups
- Assist with production issues
- Assist with training new employees
- Research and address internal requests for assistance received from the organization
- Perform other duties as assigned by leadership within the area of responsibility and control.
Competencies
REQUIRED COMPETENCIES
Required Job Skills
- Intermediate skill in use of office equipment, including copiers, fax machines, scanner and telephones.
- Intermediate PC proficiency.
- Intermediate proficiency in spreadsheet, database, flow charting, and word processing software.
- Intermediate knowledge of data mapping techniques and data analysis software.
- Intermediate knowledge of computer operating systems.
- Intermediate knowledge of Microsoft Applications and Suites, Windows Server, and Microsoft SQL databases.
Required Professional Competencies
- Strong analytical skills to support independent and effective decisions.
- Ability to prioritize tasks and work with multiple priorities, sometimes under limited time constraints.
- Perserverance in the face of resistance or setbacks.
- Effective interpersonal skills and ability to maintain positive working relationship with others.
- Systems research and analysis. Ability to write and present business intelligence documentation.
- Demonstrate the ability to stay current on global threats and vulnerabilities.
- Experience working with and managing third parties.
- Knowledge of business requirements development and user acceptance testing.
- Maintain confidentiality and privacy.
- Analytical knowledge necessary to generate reports based on available data and then make decisions based on reported data.
- Understanding of data governance best practices and data quality improvement principles.
PREFERRED COMPETENCIES
Preferred Job Skills
- Knowledge of HIPAA regulations
- Ad
