Are you interested in joining a team of experienced healthcare experts and have the ability to shape and transform the healthcare delivery system? At our family of companies, everything we do is to help improve the lives of the nearly 12 million Medicare beneficiaries we serve and 700,000 health care providers who care for them. It is our goal to help create a better health experience for all consumers. Join our winning culture and help transform Medicare for the millions of people who rely on its services.

Benefits info:
* Medical, dental, vision, life and supplemental insurance plans effective the first day of the month following date of hire
* Short- and long-term disability benefits
* 401(k) plan with company match and immediate vesting
* Free telehealth benefits
* Free gym memberships
* Employee Incentive Plan
* Employee Assistance Program
* Rewards and Recognition Programs
* Paid Time Off and Paid Sick Leave

SUMMARY STATEMENT

• The EDI Analyst is a full-time telephone help desk position that does not provide the same scheduling flexibility as other non-phone positions.
• Training hours: approximately 8:30a-5:00p EST
• Work shift hours after successful completion of training: 9:30a-6:00p EST
  

Provide analytical, technical problem-solving support, and mentoring to Medicare and other Government Contract providers, vendors, billing services and clearinghouses. Support a technical Electronic Data Interchange (EDI) help desk for a prescribed number of hours per day to support the electronic billing of Medicare claims. Analyze, troubleshoot, and support EDI telecommunications via Secure File Transfer Protocol (SFTP), Provider Portals, and Direct Data Entry (DDE) technology as well as other EDI products and services and ANSI ASC X12 format transactions.

ESSENTIAL DUTIES & RESPONSIBILITIES
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This list of essential job functions is not exhaustive and may be supplemented as necessary.

(80%) EDI Technology, Product and Services Support
* Support the telephone Help Desk queue for a prescribed number of hours per day. The incumbent works with minimal direction to analyze and solve routine customer problems but consults with a Senior EDI Analyst for more unusual situations. The incumbent has projects assigned and works on those projects within pre-established timeframes.
* Support providers in their use of electronic data interchange technology. The incumbent provides extensive telephone support regarding Medicare software and procedural/reporting questions in order to facilitate the timely and accurate submission of claims. This may include telecommunication problems, system set-up and reconfigurations, software installation, report download and submission errors, submitter security and authentication support for interactive products, all ANSI ASC X12N transactions as well as Health Insurance Portability and Accountability (HIPAA) and the Administrative Simplification Compliance Act (ASCA) regulations.
* Identify and review reporting deficiencies, analyze and evaluate test data, and pursue corrective action as required in order to ensure accurate and timely claims submissions. The incumbent assists submitters in the use of EDI technology and therefore, must be able to tailor responses and explanations to the background and technical literacy of the caller. In addition, the incumbent actively encourages the submitters to remain current in the use of EDI standard formats to ensure optimum claim processing efficiency.

(10%) Assist in Customer education to promote EDI and portal.
* Actively educate customers on new products and services to EDI. This includes promoting EDI billing, provider portals, Electronic Remittance Advice (ERA), remittance printing software, use of the Internet and other EDI products and services. This can be done through telephone contacts with customers as well through newsletter articles and listserv messages.

(5%) Monitor electronic data interchange submissions to resolve processing problems and provide reports to management.
* Monitor electronic data interchange processing through customer feedback and the utilization of system-generated reports in order to identify and review claims reporting deficiencies. As patterns of reporting problems are identified, the incumbent works with EDI staff and/or the EDI trading partners to resolve the problem as required.
* Serve as a mentor to vendors, billing services, clearinghouses, and EDI providers relative to error resolution and proactive education regarding upcoming EDI changes.

(5%) Review submitter testing for accuracy and adherence to the EDI standards in a timely manner.
* Demonstrate a thorough knowledge of EDI data specifications in the ANSI X12N formats in order to review test data from EDI submitters for accuracy and adherence to the standards. This reduces errors when the submitter begins production billing, thus saving program dollars. Tests must be reviewed, and results communicated to the submitter within two business days.

Performs other duties as the supervisor may, from time to time, deem necessary.

REQUIRED QUALIFICATIONS
* High School Diploma or GED
* 5 years' related work experience in business administration, customer service, provider enrollment or operations experience
* Demonstrated PC experience in a Microsoft Windows or similar environment
* Demonstrated oral, written and customer service skills
* Demonstrated ability to work in a fast paced and ever-changing environment
* Demonstrated effective communication skills while interfacing with provider offices, vendors, clearinghouses, and billing services regarding EDI issues, while providing technical EDI guidance and problem resolution to varying audience levels and when interfacing with EDI staff regarding EDI issues and projects.

PREFERRED QUALIFICATIONS
Additional relevant education level and/or years of experience:
* At least 1 year of Medicare experience
* Associate's Degree in Business Administration, Information Systems, or Computer Science

Additional relevant knowledge and/or skills and/or work experience:
* Knowledge of telecommunications technology
* Knowledge of EDI control logic, the pre-processing telecommunications platform, types of electronic billing formats, and telecommunications protocol concepts
* Strong problem solving, research, and decision-making skills
* Strong organizational and interpersonal skills

This opportunity is open to remote work in the following approved states: AL,AK, FL, GA, ID, IN, IO, KS, LA, MS,NE, NC, ND, OH, PA, SC, TN, TX, UT, WV, WI, WY. Specific counties and cities within these states may require additional approval. In FL and PA, in-office and hybrid work may also be available.

The Federal Government and the Centers for Medicare & Medicaid Services (CMS) may require applicants to have lived in the United States for a minimum of three (3) years out of the last five (5) years to be employed with the Company. These years of residence do not have to be consecutive.

"We are an Equal Opportunity Employer/Protected Veteran/Disabled"