Systems Analyst EDI MGMT
Heatlhcare system is currently seeking a Systems Analyst EDI MGMT for a 6 month contract opportunity in the San Diego area. The ideal candidate will possess knowledge of health care related EDI transaction sets.
Requirements for the Systems Analyst EDI MGMT
Two years’ previous experience as systems analyst within a large Health Plan preferred. Demonstration of professional level of knowledge of health plan operations, health plan software configuration, enrollment and claim file processing and trading partner management, and data processing environments. Experience analyzing complex issues and/or requests to provide effective solutions with the ability to identify root cause, communicate options and propose solutions. Knowledge of health care related EDI transaction sets. Familiarity with data communications standards and system configuration. Minimum of two years’ experience in a health care and/or health plan organization. Working knowledge of hospital, physician and health plan operations. Direct experience in project planning and system implementation. Strong analytical and problem solving skills; ability to collect and conduct interactive data analysis. Extensive knowledge of IDX, Facets, QNXT, Healthedge, HPS, and/or other administrative systems within the health plan insurance industry. Excellent written and verbal communication skills, including interaction with senior management. Ability to apply independent decision-making skills and work well under tight deadlines and multiple priorities
Responsibilities of the Systems Analyst EDIf
Systems Analyst-EDI Mgmt will support the Data Management staff in problem solving claims, enrollment and eligibility and other data issues and implementing new software applications, EDI formats and mappings, and developing reports and data extractions for the ultimate goal of streamlining processes and improving service to internal and external customers.
Data quality In collaboration with Applications Management and other departments, coordinates and completes testing of all incoming and outgoing eligibility or claims files from download to completion. Plays an integral role in the verification, validation and troubleshooting of new and current software functionality and applications. Analyzes impact of software changes on accuracy and productivity. Reports impact and potential solutions to Supervisor. Works with Applications Management and other departments to create test plans, verify data and develop automated solutions to increase efficiency and productivity.
Demonstrates system integration Participates on committees and system task forces focusing on the Health Plan’s administrative applications and projects related to data functions.
Participates in other duties as assigned Participates in special projects and other duties as assigned. These may include, but are not limited to, work groups, proposals, audits and back-up support for other departments.
Provides internal and external customer service Provides prompt, accurate and excellent services to internal and external customers. Develops solid professional working relationships with various internal departments and units and, as required, vendors, providers, employers, brokers and/or other customers.
Technical leadership Acts as liaison with internal and external customers on issues which require resolution, and for testing and implementing new products and procedures. Analyzes specific projects and statistical data with recommendations to the management team. Evaluates software solutions and makes product recommendation to the management team. Participates in the development and implementation of software functionality, upgrades and system integrations
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