Anaylst, Data Integration EDI

$62,300 - $80,000/Yr

Evolent Health - Madison, WI

Full-time - Entry Level

Madison, WI

Professional, Scientific, and Technical Services

About the position

The EDI Analyst at Evolent Health plays a crucial role in analyzing, monitoring, and resolving EDI X12 transaction data issues. This position requires collaboration with various teams to optimize processes and ensure effective communication of operational tasks. The analyst will utilize tools such as Edifecs Healthcare Suite, SQL, and PowerBI to support the organization's EDI Gateway and enhance operational efficiency.

Responsibilities

• Monitor, execute, and remediate daily EDI Gateway operational processes related to enterprise-wide production interfaces with a focus on process improvement.
• Provide EDI analysis expertise on 837 Claims, 835 Payments, and other X12 EDI data exchanges.
• Assist with data issues and initiatives related to Data Operations and EDI focus areas, including ticket triage and escalation support.
• Help operationalize tasks by defining procedures and creating SOPs for various teams.
• Communicate vital information to internal and external stakeholders regarding operational tasks and monitored processes using PowerBI/Edifecs TM.
• Monitor client inbound and outbound EDI data file extracts, remediate failures, and update operational process tickets as needed.
• Coordinate multi-team processes within Evolent business units and create process documentation in Confluence.

Requirements

• Bachelor's degree or equivalent combination of education and experience.
• 1 or more years of experience with EDI data exchanges like 837, 835, 270, 271, 276, 277, 999, and 834 Enrollment.
• Substantial knowledge of Claims, Authorization, Eligibility, and Claims status information.
• Strong interpersonal and communication skills, with experience working directly with stakeholders.
• Strong problem-solving and critical thinking skills, with experience in ambiguous situations.
• Knowledge of Healthcare Standards and CMS Rules and regulations is preferred.
• Experience developing, refining, and documenting business-related SOPs with minimal oversight is preferred.

Nice-to-haves

• Knowledge of ICD 10 and HCPCS codes fundamentals and advanced skills.
• Experience with Microsoft Suite applications (e.g., Word, Excel) and their functions.

Benefits

• Comprehensive health insurance benefits
• Bonus component based on performance factors