EDI Consultant- Benefits Eligibility - EDI 834

EDI Staffing
Linthicum Heights, MD
Sep 15, 2017
Sep 18, 2017
Full Time
Primary job responsibility is ensure the timely and accurate processing of benefit eligibility files related to membership maintained in the healthcare claims adjudication system. Major Duties and Responsibilities: Responsible for policies and processes for importing data feeds into SQL databases and applying data analysis and understanding of backend system's member matching algorithm for loading into the claims adjudication system. Responsible for supporting and testing HIPAA EDI 5010 X12 mapping formats (primary are 834,277,999) as well as other industry standard and custom formats using ETL tools. Through the application of critical thinking processes, review, evaluate, design and implement system processes which shall result in mitigated impacts of processing and data abnormalities. Implement processes that ensure highest degree of data integrity is consistently maintained. Coordinate with external clients and internal operations departments to ensure effectual setup and design of data formatting and flow for new client and/or product implementations. Own and project manage the development of ongoing implementations start to finish from client meeting and companion guide review, through internal testing process and development and into production with documentation. Design efficient solutions that ensure high degree of data accuracy and processing efficiencies. Serve as the primary point-of-contact for Eligibility related inquiries. Ensure timely distribution of daily file processing dashboards. Provides ad-hoc data/reports to clients or internal departments per request. Guide and Mentor EDI Analysts within the Department. Produce comprehensive documentation of all developed software & repositories. Automation of routine processes with appropriate monitoring controls. Other duties as assigned. Qualifications: Education: Bachelor's Degree in Computer Science or related field. Experience: Minimum of 4-6 years relevant work experience and experience in managed health care is required. Competencies: Prior experience in EDI Programmer/Analyst role Accuracy, attention to details 2 Excellent written and verbal communication skills. Ability to communicate technical issues to those outside of IT Experience in implementation of control and reconciliation reports Advanced knowledge and understanding of relational database environments Previous experience in a healthcare claims adjudication system Experience developing encounter and eligibility transactions set maps and processes in HIPAA EDI 5010 X12 Experience with an ETL and data mapping tools (eg Gentran, ITX/WTX) SQL Server database (2014) SQL Server Integration Services (SSIS) SQL Server Reporting Services (SSRS) is a plus Experience writing PL/SQL queries in Oracle or SQL Server Experience in structured, data-driven, functional logic programming Team oriented with the ability to work effectively across functional areas of the company Excellent analytical, problem resolution and people skills Ability to deliver quality results under tight deadlines Excellent customer service orientation Ability to work independently with moderate supervision Understanding of vision care insurance or health care insurance data is a plus. Experience with ITX/ITXA/WTX is preferred

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