Sr. EDI Data Analyst

Join us for an exciting career with the leading provider of supplemental benefits!

Our Promise
Through skill-building, leadership development and philanthropic opportunities, we provide opportunities to build communities and grow your career, surrounded by diverse colleagues with high ethical standards.

Our chosen EDI Data Analyst will ensure accurate and timely Encounter/Rejection file processing for submission to the respective State and/or client. This individual will utilize their knowledge of overall claims processing to provide input on Encounter/Rejection opportunities for improvements and to resolve/reduce Encounter Rejection errors.

Core Competencies:

• Collegiality: Building strong relationships on company-wide, approachable, and helpful, ability to mentor and support team growth.
• Initiative: Readiness to lead or take action to achieve goals.
• Communicative: Ability to relay issues, concepts, and ideas to others easily orally and in writing.
• Member-focused: Going above and beyond to make our members feel seen, valued and appreciated.
• Detail oriented and thorough: Managing and completing details of assignments without too much oversight.
• Flexible and responsive: Managing new demands, changes, and situations.
• Critical Thinking: Effectively troubleshoot complex issues, problem solve and multi-task.
• Integrity & responsibility: Acting with a clear sense of ownership for actions, decisions and to keep information confidential when required.
• Collaborative: Ability to represent your own interests while being fair to those representing other or competing ideas in search of a workable solution for all parties.

Essential Functions:

• Engage actively with the Encounter and Implementation teams to understand the steps of the encounter/rejection process for states/clients.
• Participate in State/Client Encounter discussions, acting as a subject matter expert and providing input on suggested process improvements.
• Accurately interpret and understand 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. Improve process as business dictates.
• Resolve escalated issues on behalf of EDI staff; work with internal staff as needed to ensure the resolution of escalated issues related to Encounters/Rejections.
• Analyze exception data and correct code errors/issues. Submit accurate and timely Encounter Acceptance Rate Reports.
• Identify trends and inefficiencies in procedures, reports, and workflow to support continuous improvement.     
• Provide feedback to the manager on recommendations for additional training or coaching to foster continued staff development.     
• Partner with the management team to resolve potential issues and concerns.

Minimum Qualifications:

• 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).
• As this role is a remote role, you are required to maintain internet service that allows you to complete your essential job duties without issue. Rates of 50 Mbps download and 10 Mbps upload while hardwired and not on a VPN are sufficient.

FLSA Status: Salary/Exempt

National Salary Range: $61,360 - $96,040

How to stay safe:

Avesis is aware of fraudulent activity by individuals falsely representing themselves as Avesis recruiters. In some instances, these individuals may even contact applicants with a job offer letter, ask applicants to make purchases  (i.e., a laptop or gift cards) from a designated vendor, have applicants fill out W-2 forms, or ask that applicants ship or send packages of goods to the company.

Avesis would never make such requests to applicants at any time throughout our job application process. We also would never ask applicants for personal information, such as passport numbers, bank account numbers, or social security numbers, during process. Our recruitment process takes place by phone and via trusted business communication platform (i.e., Zoom, Webex, Microsoft Teams, etc.). Any emails from Avesis recruiters will come from a verified email address ending in @Avesis.com.

We urge all applicants to exercise caution. If something feels off about your interactions, we encourage you to suspend or cease communications. If you are unsure of the legitimacy of a communication you have received, please reach out to ITsupport@Avesis.com.

To learn more about protecting yourself from fraudulent activity, please refer to this article link (https://consumer.ftc.gov/articles/how-avoid-scam).  If you believe you were a victim of fraudulent activity, please contact your local authorities or file a complaint (Link: https://reportfraud.ftc.gov/#/) with the Federal Trade Commission. Avesis is not responsible for any claims, losses, damages, or expenses resulting from unaffiliated individuals of the company or their fraudulent activity.

We Offer

• Meaningful and challenging work opportunities to accelerate innovation in a secure and compliant way.
• 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. We volunteer within our local communities, create educational alliances with colleges, drive a variety of initiatives in sustainability.

Equal Employment Opportunity

At Avēsis, We See You.  We celebrate differences and are building a culture of inclusivity and diversity. We are proud to be an Equal Employment Opportunity employer that considers all qualified applicants and does not discriminate against any person based on ancestry, age, citizenship, color, creed, disability, familial status, gender, gender expression, gender identity, marital status, military or veteran status, national origin, race, religion, sexual orientation, or any other characteristic.  At Avēsis, we believe that, to operate at the peak of excellence, our workforce needs to represent a rich mixture of diverse people, all focused on providing a world-class experience for our clients.  We focus on recruiting, training and retaining those individuals that share similar goals.  Come Dare to be Different at Avēsis, where We See You!