Senior EDI Analyst

 
Position: Senior EDI Analyst

Job ID: 152090

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

Texas Children’s Health Plan (TCHP) is the largest Texas Medicaid managed care organization, and is part of the Texas Children’s healthcare system. Founded in 1996, TCHP is the nation's first health maintenance organization (HMO) created just for children and pregnant women. Our plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area. Currently the Health Plan serves more than 450,000 members across three service areas (Harris, Jefferson, North East). Members of the plan receive care from our network of more than 4,000 primary care physicians, 8,000 specialists, and 110 hospitals. They can also receive care at The Center for Children and Women, a patient and family-centered medical home with two convenient locations for TCHP members who can have all their medical needs met in one place, receiving multiple services the same day. TCHP is a recognized leader at encouraging holistic care that empowers families to live healthier lives.   To join our community of 13,000 dedicated team members, visit www.texaschildrenspeople.org for career opportunities.   You can also learn more about our amazing culture at www.infinitepassion.org

Summary:

We are searching for a Senior EDI Analyst – Someone who implements and maintains health plan electronic data interchange, (EDI), standards by identifying EDI solutions based on business needs and technical requirements. The Senior EDI Analyst is responsible for working with business clients, 3rd party vendors and technical developers to interpret and document requirements, create data mapping documentation, design, test, and follow change management procedures to implement data interchange solutions. The Senior EDI Analyst is a subject matter expert in X12 HIPAA transaction sets, (primarily the professional and institutional claims 837 and the eligibility 834 transaction sets), and is responsible for interpreting state X12 requirements, authoring transaction companion guides, and analyzing claims and eligibility transaction data in problem solving. Additionally, they will represent the team in a lead role in developing process improvements, documenting policy, providing training and representing EDI on project teams.

 



Responsibilities :

  • Reviews implementations, conducts testing, and assists with new releases
  • Collaborate with business stakeholders to document business processes and new requirements for data integration solutions and reports
  • Perform data analysis in response to requests from business stakeholders and recommend options to improve data accuracy
  • Work with trading partners to resolve any operational issues
  • Coordinate and test all EDI implementations with new EDI partners
  • Analyze current implementation in order to make recommendations for improvements
  • Assists with the testing of new releases on the claims processing system and trouble shoots problems prior to loading into
    production
  • Assists with projects including group and vendor implementations and data projects
  • Establish and maintain process definition for EDI processing
  • Creating mapping for import and processing of proprietary and ANSI HealthCare X12 electronic data files
  • Conducting system & integration testing
  • Performs daily monitoring of EDI file processing and trouble shoots issues impacting successful file transfer
  • Communicates with vendors and clients regarding day-to-day EDI transactions
  • Query databases in response to business inquiries
  • Oversees the production support of existing EDI trading partners
  • Monitor the production environment and proactively prioritize, communicate, and resolve any EDI process or system issues
  • 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
  • Monitor, audit, and report on the processing of newly implemented trading partners to confirm their successful transition
    to the production environment.
  • Provides support and researches solutions for user issues which cannot be resolved by the Service Desk.


Qualifications:

  • Knowledge of HIPAA regulations and requirements
  • ETL and database tools such as SSMS, SSRS, and SSIS
  • Working knowledge of the Affordable Care Act/Health Insurance Exchange
  • Experience on healthcare insurance payer systems
  • High school diploma or GED required
  • 6 years’ experience working in healthcare, with a HMO or MCO, or with HIPAA HealthCare X12 EDI transactions or a bachelor’s degree substituting for 4 years of experience


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