Anaylst, Data Integration EDI

$62,300 - $80,000/Yr

Evolent Health - Santa Fe, NM

Full-time - Entry Level

Santa Fe, NM

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 enhance operational processes and ensure effective communication of vital information to stakeholders. The role emphasizes continuous improvement in EDI operations and supports the organization's mission to provide better healthcare outcomes.

Responsibilities

• Monitor, execute, and remediate daily EDI Gateway operational processes related to enterprise-wide production interfaces.
• Provide EDI analysis expertise on 837 Claims, 835 Payments, and other X12 EDI data exchanges.
• Work on data issues and initiatives related to Data Operations and EDI focus areas, including ticket triage and escalation support.
• Assist other teams in operationalizing tasks by defining procedures and creating SOPs.
• Communicate vital information with internal and external stakeholders regarding daily operational tasks and monitored processes.
• Monitor client inbound and outbound EDI data file extracts, remediating failures as they arise.
• Coordinate multi-team processes within Evolent business units and create process documentation for training purposes.

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 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 in claims correction and troubleshooting EDI errors.

Benefits

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