Sr. EDI Data Analyst

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Our chosen EDI Data Analyst will ensure accurate and timely Encounter/Rejection file processing for submission to the respective State and/or client. This individual will utilize their knowledge of overall claims processing to provide input on Encounter/Rejection opportunities for improvements and to resolve/reduce Encounter Rejection errors.

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 …