Senior EDI Data Analyst

4 days ago

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Avēsis

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commercial and government vision insurance • essential benefits • benefits administration • employee benefits • ancillary benefits

501 - 1000

Description

• Ensure accurate and timely Encounter/Rejection file processing. • Provide input on Encounter/Rejection opportunities for improvements. • Engage actively with the Encounter and Implementation teams. • Participate in State/Client Encounter discussions. • Accurately interpret State Encounter/Rejection requirements for multiple markets. • Develop and maintain controls over the Encounter processed data and systems. • Oversee the auditing process and monitor exposure and potential penalty risk. • Resolve escalated issues on behalf of EDI staff. • Identify trends and inefficiencies in procedures to support continuous improvement.

Requirements

• Associate degree in Business Administration/or Healthcare related field or 5-7 years of related work experience. • 3-5 years of prior job-related experience demonstrating strong analytical capabilities in claims/encounter processing. • 3-5 years of Strong SQL experience (create multi-level queries, database maintenance – backup and restore, execute stored procedures, interface with other apps using SDK/API). • Strong knowledge of database application and data query protocol (MS SQL Server, Transact-SQL). • 3-5 years comprehensive experience claim processing/resolution. • 2-3 years experience with standard EDI file formats and protocols such as 837P, 837D, 835, 834, 277, 999. • Excellent knowledge ADA, CPT and HCPCS procedures and codes. • Basic knowledge of Microsoft software (Outlook, Excel, and Word).

Benefits

• Competitive compensation package. • Excellent medical, dental, supplemental health, life and vision coverage for you and your dependents with no wait period. • Life and disability insurance. • A great 401(k) with company match. • Tuition assistance, paid parental leave and backup family care. • Dynamic, modern work environments that promote collaboration and creativity to develop and empower talent. • Flexible time off, dress code, and work location policies to balance your work and life in the ways that suit you best. • Employee Resource Groups that advocate for inclusion and diversity in all that we do. • Social responsibility in all aspects of our work.