EDI Analyst - Remote

Software Guidance & Assistance - Los Angeles, CA

Full-time - Mid Level

Remote - Los Angeles, CA

Professional, Scientific, and Technical Services

About the position

The EDI Analyst plays a crucial role in managing and maintaining electronic claims and EDI transactions for a healthcare client. This position involves collaborating with external trading partners, ensuring secure data transfers, and testing files from new providers. The role is essential for the New Century Health Plan and is fully remote.

Responsibilities

• Maintain and run processes/jobs for electronic claims and other EDI transactions.
• Work with external trading partners to transfer data through secure channels.
• Load data to the production environment.
• Test files from new providers/trading partners.

Requirements

• Bachelor's Degree in Business Administration, Information Systems, Health Care, or a related field, or equivalent education and experience.
• Minimum of five (5) years' experience with CMS processes in a Medicare or Managed Care environment managing claims or encounters.
• Extensive experience with Claims Encounter strategy and processes.
• Strong understanding of claims payment methodologies, adjudication processing, and Federal encounter regulations.
• Advanced knowledge of SQL, SSIS package, and MS Office.

Nice-to-haves

• Knowledge of encounter regulatory reporting and compliance requirements.

Benefits

• Remote work opportunity
• Diverse team environment
• Equal Opportunity Employer commitment