EDI Analyst - STAR Kids Administration - Health Plan

 
Position: EDI Analyst - STAR Kids Administration - Health Plan

Job ID: 140141

Location: US-TX-Houston

Department: STAR KIDS - ADMIN

Talent Area: Information Services

Full/Part Time: Full-Time

Regular/Temporary: Regular

Shift: 8a - 5p

About Texas Children's Hospital

Texas Children’s Health Plan Founded in 1996, Texas Children’s Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.   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 EDI Analyst - someone who works well in a fast-paced hospital setting. In this position, you’ll be responsible for implementing and maintaining EDI technical standards, identifying EDI solutions to business needs and overall process improvement. You’ll be 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.

 

Think you’ve got what it takes?

 



Responsibilities :

  • Bachelor's Degree in Business, Information Technology, Computer Information Systems, Systems Engineering, related fields or four (4) years of related work experience may substitute for the bachelor’s degree 
  • Previous experience in Health Care, or with an HMO or MCO organization 
  • Ability to learn HIPAA regulations and requirements 
  • Ability to learn HIPAA EDI transactions (820, 270, 271, 834, 837, 270, 271 etc.) and other file formats 
  • ETL and database tools such as SSMS, SSRS, and SSIS 
  • Knowledge of Healthcare Business Systems desired 
  • Skill in critical thinking, problem analysis, and process documentation. 
  • Excellent documentation, verbal and written communication and interpersonal skills

 

 



Qualifications:

  • Monitors EDI file processing daily
  • Communicates with vendors and clients regarding EDI backend transactions as needed
  • Troubleshoots issues impacting successful receipt, delivery or processing of files; performing root cause analysis
  • Conducts queries of databases in response to business inquiries
  • Monitors, reports and tracks error trends to manage resolution initiatives for EDI backend processes
  • Receives calls forwarded from Service Desk, which cannot be resolved by Service Desk
  • Communicates with users to determine the problem
  • Identifies scope of problem and impact to other users
  • Analyzes problem and researches alternative solutions
  • Determines appropriate solution and makes necessary changes
  • Works with trading partners to resolve any operational issues
  • Coordinates and tests all EDI implementations with new EDI partners
  • Analyzes current implementation in order to make recommendations for improvements

 



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