Healthcare Junior Data Analyst

Verda Healthcare, Inc. has a contract with the Center of Medicaid and Medicare Services (CMS) and Texas Department of Insurance (TDI) for a Medicare Advantage Prescription Drug (MAPD) plan for 2024. We are looking for a Junior Data Analyst to join our growing company with many internal opportunities.

Are you ready to join a company that is changing the face of health care across the nation? Verda Healthcare, Inc. is looking for people like you who value excellence, integrity, caring and innovation. As an employee, you’ll join a team dedicated to improving the lives of our Medicare members. Our vision incorporates value-based health care that works. We value diversity.

Align your career goals with Verda Healthcare, Inc. and we will support you all the way.

Position Overview

The Junior Data Analyst role will help to plan, create, analyze, and implement electronic data interchange (EDI) systems and supporting processes using best business practice knowledge. This role will also ensure these systems are working properly to enable the efficient exchange of information between organizations and/or among internal units within Verda Healthcare. The Junior Data Analyst will also be assisting the EDI team in maintaining and running processes and jobs for electronic claims and other EDI transactions, which include working with external trading partners, transferring data through secure channels, loading the data to the production environment, and testing files from new providers and trading partners. This professional will be responsible for assessing the business needs and challenges and identifying ways to optimize these systems to best serve those purposes. It also includes testing, maintenance, and troubleshooting.

Essential Functions

• Monitor the ingestion/intake, extraction, and reconciliation of member data files from all sources. Additionally, the submission of files to our partner vendors or CMS, if applicable.
• Create, develop, and produce mapping documents for intake and extraction.
• Document all analysis and reporting projects following established department protocols to ensure transparency and repeatability.
• Understand data sets and formats such as XML. Ansi X12/HL7 standards like 820, 834,835,837,277,278, 22 and 999 (Documentation and Training will be included).
• Understand industry operations standards such as Capitation, Risk Pool, RAF, and Broker Commission (Documentation and Training will be included).
• Creates workflow and notification to department of arrival of files and schedule file deliveries to external vendors.
• Request and maintain SFTP connections and rules including resolving transmission problems with partners.
• Coordinate testing the electronic transactions with trading partners and other certification authorities for projects such as ICD-10 and CORE. Assist EDI team in diagnosing problems with inbound claims, providing assistance to Claims, Member Services, and Provider Relations department staff.
• Work with internal and external implementation teams and work cross-functionally between the business and IT to resolve technical issues.
• Develop SDLC (Software Development Life Cycle) documents such as Business Requirement Document, Process Flow, Business Case Study Document, and Test Case Document.
• Research, analyze, and evaluate technical requirements and specifications for the seamless integration of EDI solutions.
• Analyze and complete EDI requests on time and with high quality including resolving trouble tickets and providing technical solutions.
• Work with programming staff on data formatting/mapping of electronic data and transmission related tasks and issues.

Responsibilities:

• Coordinates provider directory information exchange with IPAs, PPO vendor, and physician organizations.
• Create and modify mapping documents based on Verda needs and analyze requirements, test systems, export data in EDI formats, and be able to load and transform EDI files into accessible data formats.
• Assist with database management of all EDI files for Verda.
• Create workflows for data correction and error processing with business units.
• Collaborate with other departments to research, identify and correct data errors to minimize ongoing rejection risk.
• Primary resource researching and analyzing encounter edits or rejections and work with internal/external teams to resolve.
• Maintain detailed documentation and process flow of all EDI processes.

Minimum Qualifications

• Bachelor's degree in business, computer science, information systems or information technology, or equivalent experience.
• Proven ability to impact process improvement and process management.
• Must understand relational database concepts, table design and structure, joins, data normalization, and data types.
• Experience with SQL is required (At least 1 years).
• Thorough knowledge of MS Office Suite, particularly Excel.

Professional Competencies

• Collaborative approach with vendors and partners
• Strong analytical skills
• Skilled at requirements gathering, problem analysis and problem solving
• Effective verbal and written communication

Salary Range: $60,000 - $120,000