Sr. EDI Data Analyst
Work From Home - AZ
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Join us for an exciting career with the leading provider of supplemental benefits!
Our Promise
Through skill-building, leadership development and philanthropic opportunities, we provide opportunities to build communities and grow your career, surrounded by diverse colleagues with high ethical standards.
Core Competencies:
- Collegiality: Building strong relationships on company-wide, approachable, and helpful, ability to mentor and support team growth.
- Initiative: Readiness to lead or take action to achieve goals.
- Communicative: Ability to relay issues, concepts, and ideas to others easily orally and in writing.
- Member-focused: Going above and beyond to make our members feel seen, valued and appreciated.
- Detail oriented and thorough: Managing and completing details of assignments without too much oversight.
- Flexible and responsive: Managing new demands, changes, and situations.
- Critical Thinking: Effectively troubleshoot complex issues, problem solve and multi-task.
- Integrity & responsibility: Acting with a clear sense of ownership for actions, decisions and to keep information confidential when required.
- Collaborative: Ability to represent your own interests while being fair to those representing other or competing ideas in search of a workable solution for all parties.
Essential Functions:
- Engage actively with the Encounter and Implementation teams to understand the steps of the encounter/rejection process for states/clients.
- Participate in State/Client Encounter discussions, acting as a subject matter expert and providing input on suggested process improvements.
- Accurately interpret and understand State Encounter/Rejection requirements for multiple markets.
- Develop and maintain controls over the Encounter processed data and systems.
- Oversee the auditing process and monitor exposure and potential penalty risk. Improve process as business dictates.
- Resolve escalated issues on behalf of EDI staff; work with internal staff as needed to ensure the resolution of escalated issues related to Encounters/Rejections.
- Analyze exception data and correct code errors/issues. Submit accurate and timely Encounter Acceptance Rate Reports.
- Identify trends and inefficiencies in procedures, reports, and workflow to support continuous improvement.
- Provide feedback to the manager on recommendations for additional training or coaching to foster continued staff development.
- Partner with the management team to resolve potential issues and concerns.
Minimum Qualifications:
- Associate degree in Business Administration/or Healthcare related field or 5-7 years of related work experience.
- 3-5 years of prior job-related experience demonstrating …
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Benefits/PerksLeadership development Philanthropic opportunities Skill-building
Tasks- Resolve escalated issues
Ada Auditing Claims processing Collaboration Communication CPT CPT codes Critical thinking Database Maintenance EDI Excel HCPCS Leadership Development Microsoft Excel Microsoft Outlook Microsoft Word MS SQL Server Recruiting SQL Training
Experience5-7 years
EducationAssociate degree Business Administration Healthcare Healthcare related field
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