Vba Developer - Hybrid Role

GENERAL SUMMARY:

The EDI Systems Analyst is responsible for providing analysis and supporting internal and external customers on complex Electronic Data Interchange issues. Responds to complex inquiries relating to EDI from providers and internal departments. Incumbents tasked with managed care configuration and maintenance focus on EzCap and EzNet systems.

ESSENTIAL RESPONSIBILITIES:

• Develop technical specifications for EDI application interfaces; provide regular testing and technical support during and after implementation of healthcare EDI applications and updated transaction formats.
• Respond to regular EDI inquiries and troubleshoot issues from internal organizations, trading partners and vendors regarding healthcare transactions (claims, enrollment, payments, encounter, etc.) and clearinghouse activities.
• Conduct various analyses of EDI transactions and formats; handle format mapping and other EDI documentation as well as various EDI reporting.
• Provide and communicate local expertise regarding standard concepts, practices and procedures of EDI formats (proprietary, NSF, ANSI, HIPAA).
• Research, evaluate and implement vendor partner initiatives and manage end-to-end implementation process (provider evaluation/coordination, vendor evaluation/coordination, completing of banking and contractual agreements, provider setup, testing and evaluation).
• Audit claims for coding accuracy, benefit payment, contract interpretation and compliance with policies and procedures.
• Respond to audit rebuttals.
• Exercise discretion and independent judgment with critical analysis, offering solutions and expert advice to management.
• Performs other duties as required.

INCUMBENTS TASKED WITH MANAGED CARE CONFIGURATION AND MAINTENANCE:

• Build and maintain contracted and non-contracted provider fee schedules.
• Review Medicare and Medicaid bulletins to stay abreast of regulation changes.
• Conduct ongoing fee schedule audits to ensure accurate billing and identify areas of concern.
• Act as liaison between outside providers and insurance team to assist in problem resolution.
• Performs other duties as required.

JOB SPECIFICATIONS:

• High School Diploma. Associate’s Degree preferred.
• 1-3 years of experience in data analysis in a customer service environment within healthcare insurance industry.
• Intermediate to advanced skills in MS ACCESS.
• Demonstrated analytical, problem solving and critical thinking skills.
• Experience with industry software for HIPPA pre-production transaction testing
• Excellent communication and presentation skills.
• Highly self-motivated and able to work well in a fast-paced environment.

INCUMBENTS TASKED WITH FEE SCHEDULING ADDITIONAL SPECIFICATIONS:

• EzCap & EzNet experience preferred.
• CPC or CCS certification preferred.
• Thorough knowledge and working experience of CPT and ICD-10 codes, UB04 and HCFA 1500 claim forms and 837 files.
• Proficiency with Tableau.
• Proficiency with Microsoft Office programs; primarily Excel and Access, with excellent documentation skills.
• Detail-oriented with the ability to work under pressure with frequent interruptions without being distracted.
• Proof of Covid vaccine

EEO Statement

Element Care is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, sex, color, religion, national origin, sexual orientation, protected veteran status, or on the basis of disability.

Element Care is committed to valuing diversity and contributing to an inclusive working environment.