EDI Analyst Sr

 
Position: EDI Analyst Sr

Job ID: 145693

Location: US-TX-Houston

Department: TCHP IS SUPPORT

Talent Area: Information Services

Full/Part Time: Full-Time

Regular/Temporary: Regular

Shift: 8a-5p

About Texas Children's Hospital

Since 1954, Texas Children’s has been leading the charge in patient care, education and research to accelerate health care for children and women around the world. When you love what you do, it truly shows in the smiles of our patient families, employees and our numerous accolades such as being consistently ranked as the best children’s hospital in Texas, and among the top in the nation by U.S.News & World Report as well as recognition from Houston Business Journal as one of this city’s Best Places to Work for ten consecutive years. Texas Children’s comprehensive health care network includes our primary hospital in the Texas Medical Center with expertise in over 40 pediatric subspecialties; the Jan and Dan Duncan Neurological Research Institute (NRI); the Feigin Center for pediatric research; Texas Children’s Pavilion for Women, a comprehensive obstetrics/gynecology facility focusing on high-risk births; Texas Children’s Hospital West Campus, a community hospital in suburban West Houston; and Texas Children’s Hospital The Woodlands, a second community hospital opening in 2017. We have also created the nation’s first HMO for children, established the largest pediatric primary care network in the country and a global health program that is channeling care to children and women all over the world. Texas Children’s Hospital is also academically affiliated with Baylor College of Medicine, one of the largest, most diverse and successful pediatric programs in the nation.   To join our community of 13,000 dedicated team members, visit texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at infinitepassion.org.    

Summary:

We are searching for a Senior EDI Analyst – someone who works well in a fast-paced setting. In this position, you will implement and maintain EDI technical standards, identifying EDI solutions to business needs and overall process improvement. Responsible for the development, implementation and ongoing maintenance of the HIPAA 837 (claims), 835 (remittances), 276/277 (claims status inquiry and response), 270/271 (Eligibility Inquiries), 278 (referral/prior authorization) EDI transactions and any other EDI transactions. Responsibilities also include planning, implementing and managing HIPAA EDI projects relating to these transactions, including end-user contact, analysis, requirements identification, design, mapping, development, training and documentation. Additionally, functions as team lead and conducts training of new processes, process changes and policies of other team members and functions as integral part of special project teams.

 

Think you’ve got what it takes?

 

 



Responsibilities :

  • Performs daily monitoring of EDI file processing and troubleshoots issues impacting successful file transfer
  • Perform routine and ad hoc analysis of various facets of EDI processing including but not limited to system performance, claim turnaround times, data mapping, and claim volumes
  • Prepare and maintain documentation that defines operational procedures, describes client requirements, and shares relevant analysis outcomes with internal and external stakeholders
  • Provides support and researches solutions for user issues and enhancement requests which cannot be resolved by the Service Desk, including communicating with the business to determine the problem and document requirements
  • Identifies scope of work and impact to other users
  • Analyzes problem or enhancement request and researches alternative solutions
  • Determines appropriate solution and works with developer to design and develop solution
  • Escalate and partner with other IT teams to escalate problem to other Information Services staff as necessary to implement enhancements and detect fixes
  • Reviews implementations, conducts testing, and assists with new release
  • Creating mapping for import and processing of proprietary and ANSI HealthCare X12 electronic data files

 

 



Qualifications:

  • Knowledge of HIPAA HealthCare X12 EDI transactions (particularly 270/271, 276/277, 834, 835, 837P, 8371, and 837D) and other common healthcare file formats
  • Experience with ETL and database tools such as SSMS, SSRS, and SSIS
  • Strong technical experience in EDI Mapping tools, Trading Partner Configuration, Databases (SQL Server), Reporting
  • Experience in healthcare insurance payer systems
  • 2 years of experience working with HIPAA HealthCare X12 EDI transactions
  • Bachelor's Degree in Business, Information Technology, Computer Information Systems, Systems Engineering, related fields
  • Four (4) years of related professional data interchange experience may be substituted for the Bachelor’s degree
  • Previous experience in Health Care or with an HMO or MCO organization preferred

 



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