EDI Analyst, Medicaid EDI and Intake Business Operations

$60,300 - $145,860/Yr

CVS Health - Irving, TX

Full-time - Mid Level

Irving, TX

Health and Personal Care Retailers

About the position

The EDI Analyst for Medicaid EDI and Intake Business Operations at CVS Health is responsible for ensuring the quality and integrity of EDI and Intake processes for Medicaid transactions. This role involves liaising with providers regarding EDI and claims intake rejections, serving as a technical subject matter expert (SME), and collaborating with IT teams for system enhancements. The analyst will also provide expert support for EDI rejections and utilize technical skills to analyze large datasets for troubleshooting.

Responsibilities

• Support Product Owners, Business Owners, and Leads with technical and analytical expertise in EDI and Claims processing.
• Interface and communicate with various levels of the organization, coordinating with Operations, SMEs, and IT teams.
• Drive requirements for claim intake rules and liaise with Agile teams.
• Create, update, and maintain documentation surrounding EDI and Intake rules.
• Perform analysis of EDI and Claims intake rejections and execute solutions.
• Act as a Subject Matter Expert on EDI transactions and build ad hoc queries for data analysis.
• User Acceptance Test logic changes and enhancements.

Requirements

• 2+ years working on EDI transactions including 837s, 277s, 999s, 275s, 835s.
• 2+ years of project management experience in EDI and Claims operations.
• 5+ years of data interpretation and analysis experience.
• 5+ years of demonstrated leadership experience.
• 5+ years querying large datasets using SQL, SAS, or other data tools.
• Proficient in Word, PowerPoint, and Excel.
• Excellent verbal and written communication skills.

Nice-to-haves

• Demonstrated ability with Excel (pivots, formulas, and V-look up).
• Flexibility and willingness to adapt to team needs.
• A life learner constantly improving professional knowledge.
• A process improvement mindset.

Benefits

• Medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Employee Stock Purchase Plan.
• Fully-paid term life insurance plan.
• Short-term and long-term disability benefits.
• Well-being programs and education assistance.
• Free development courses.
• CVS store discount and discount programs with partners.
• Paid Time Off (PTO) and paid holidays.