EDI Analyst


Community Health Group is a locally based non-profit health plan that ensures access to high quality, culturally sensitive health care for underserved communities throughout San Diego County. We treat our 300-member, multi-lingual staff like family, encouraging an atmosphere of collaborative teamwork, continuous learning, personal growth, and promotion from within. Recognized as one of the Top Workplaces in San Diego, CHG offers its employees such benefits as tuition reimbursement, a meditation room and yoga classes, a monthly Breakfast With The CEO, and memorable events throughout the year. 

We know that by serving our employees well, they, in turn, will better serve our nearly 300,000+ membership. We have been recognized consistently for the excellence and sensitivity of our customer service by members, physicians, vendors, and a full range of health care providers. We are accredited by the National Committee for Quality Assurance and proud of our continuing company-wide Quality Initiatives.

We are currently recruiting for:

EDI Analyst

POSITION SUMMARY

The EDI Analyst primary responsibilities include all processes and duties within the EDI Business scope.  The EDI Analyst role is to plan, design, implement, and test the EDI systems in support of Community Health Group core functions and business processes. The EDI Analyst will ensure that intensive business analysis, detailed architectural design, and thorough planning are all incorporated in each of the EDI Processes to ensure the highest level of data quality.  This position will proactively seek opportunities that will assist Community Health Group in enhancing revenue and reduce expenses as well as staying compliance with the regulatory agencies.

 

COMPLIANCE WITH REGULATIONS:

Works closely with all departments necessary to ensure that the processes, programs and services are accomplished in a timely and efficient manner in accordance with CHG policies and procedures and in compliance with applicable state and federal regulations including CMS and/or Medicare Part D, DHCS, and Council for Affordable Quality Healthcare Committee on Operating Rules for Information Exchange (CAQH CORE).

 

RESPONSIBILITIES

This position will be involved in multiple activities related to Community Health Group’s EDI operations which include:

  • Analyze, process, and troubleshoot HIPAA/EDI X12 ANSI 5010 healthcare transactions

    • 837

    • 999

    • 277CA

    • 835

    • 834

    • 820

    • 274

    • 278

    • 270 – 271

    • 276 – 277

  • Analyzes, designs, tests, and implements EDI components between QNXT and CHG systems

    • Configures and maintains BizTalk

    • Configures and maintains QNXT EDI modules

    • Configures and maintains CHG EDI Manager

    • Configures and maintains TIBCO

  • Expert in HL7

  • Expert in HL7 FHIR

  • Expert in RAPS and RISK Score

  • Expert in CHG Revenue Calculation

  • Expert in ONC and CAQH CORE Rules

  • Expert and a lead in ICD conversion

  • Generate Reports in Tableau

  • Work with all trading partners, including Clearinghouses and Providers to ensure high degree of data accuracy and processing efficiencies

  • Coordinate EDI trading partner implementations and ensure that all guidelines, specifications, and policies are adhered to

  • Provide assistance and a back-up for Encounter Data processes for CMS and DHCS

  • Provide assistance and configure SFTP account

  • Provide assistance to a Senior EDI analyst on Core Administrative Payment Software upgrade and conversion

  • Monitor Core Administrative Payment Software Vendor’s site for updates and defects

  • Create Policy and Procedures

  • Expert in in Medicare Plan Communications User Guide’s data files

  • Serve as EDI subject matter expert

  • Provide training for all higher level EDI processes

  • Manage full cycle EDI Process

  • Provide ad-hoc data\reports as request

  • Test I.S. monthly Maintenance System

  • Provide timely communication on status and issues on a weekly basis

  • Other duties as assigned    

  • Education:          

  • Bachelor’s Degree in Computer Science, Computer Engineering, or Information Systems.

     

    Experience/Skills:
  • Proficient in generating SQL scripts and/or PL/SQL
  • Accuracy, attention to details, and analytical skills
  • Excellent analytical and problem solving skill
  • Knowledge of relational databases
  • Knowledge of XML
  • Proficient in EDI transactions
  • Proficient in HL7 transactions
  • Knowledge of Risk Score
  • Knowledge of Biztalk 2010
  • Excellent oral and written communication.
  • Good analytical, logical and organization skills.
  • Excellent time management; able to work on multiple projects concurrently.
  • Ability to adhere to security requirements and confidentiality as required by the company and HIPAA.
  • Ability to deliver quality result under tight deadlines
  • Ability to work independently with moderate supervision
  • Ability to operate personal computers and other related peripherals
  • Microsoft Office

Physical Requirements:

  • May be required to work evenings and/or weekends.