Senior Healthcare HIPAA EDI Data Analyst

Overview

TISTA Science and Technology is seeking a Senior Healthcare HIPAA EDI Data Analyst who will work as a subject matter expert working with EDI data and business processes. 

TISTA associates enjoy above Industry Healthcare Benefits, Remote Working Options, Paid Time Off, Training/Certification opportunities, Healthcare Savings Account & Flexible Savings Account, Paid Life Insurance, Short-term & Long-term Disability, 401K Match, Tuition Reimbursement, Employee Assistance Program, Paid Holidays, Military Leave, and much more!

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Responsibilities

• Provides subject-matter expertise on available data and quantitative solutions
• Identifies the best combination of available data, analytical methods, and presentation for analytic solutions
• Analyzes business data for actionable intelligence
• Evaluates data-centric tasks to determine the appropriate analytic approaches
• Coordinates work of data analysts, providing subject-matter expertise and guidance
• Performs data-mining, modeling and develop customized algorithms to solve analytical problems with incomplete data sets
• Develops proper algorithms in order to establish the desired linkage between the existing data in the warehouse and the new data set
• Tracks data lineage of benefits to cost, eligibility and enrollment data, provider to beneficiary, and program to utilization
• Collaborates with product management and engineering team to understand needs and devise possible solutions
• Keeps up-to-date with latest technology trends

• Oversee Comprehensive EDI Transactions:Manage and ensure the smooth execution of all HIPAA-compliant EDI transactions, including:
  • 837: Claims (Institutional, Professional, Dental)
  • 835: Payment and Remittance Advice
  • 270/271: Eligibility and Benefits Inquiry/Response
  • 276/277: Claim Status Inquiry/Response
  • 278: Referrals and Authorizations
  • 834: Benefit Enrollment
  • 820: Premium Payments

• Optimize Transaction Lifecycles:Analyze the entire EDI transaction lifecycle to identify bottlenecks, errors, and inefficiencies, implementing data-driven solutions to streamline processes and improve performance.

• Error Resolution and Collaboration:Lead initiatives to address and resolve claim rejections, eligibility errors, and payment discrepancies. Collaborate with providers, payers, and clearinghouses to maintain seamless data exchange and compliance.

• Technical Expertise:
  • Possess extensive experience with HIPAA-compliant EDI transactions and ASC X12 standards.
  • Leverage proficiency in EDI tools, mapping technologies, and data transformation platforms.
  • Demonstrate strong knowledge of healthcare coding standards, including ICD-10, CPT, HCPCS, and NDC.

• Advanced Data Analysis:
  • Troubleshoot complex EDI issues using tools such as SQL, mapping software, and integration platforms.
  • Optimize database queries and develop detailed reports to provide actionable insights on EDI data trends and system performance.

• Leadership and Process Improvement:Act as the primary point of contact for all EDI-related issues, ensuring timely resolution and fostering continuous process enhancements to improve efficiency and compliance.

• Cross-Functional Collaboration:Partner with IT, compliance, operations, and other stakeholders to design, implement, and refine EDI solutions aligned with organizational objectives.

• Mentorship and Team Development:Provide mentorship to junior analysts, sharing knowledge and expertise to foster team development and ensure consistency in EDI operations.

Qualifications

• 5 yrs relevant experience in data-mining, modeling and EDI based transactions
• Experience mapping and supporting EDI based transactions i.e., 837, 835, 270/271, 276/277, 278, 834, and 820
• Knowledge of EDI, X12/EDIFACT standards and practices, and EDI translators
• EDI experience (setup, mapping, testing, processing, troubleshooting)
• Proficient in EDI layouts (loops, segments, data elements)
• Perform EDI onboarding and testing with applicable third-party providers
• Create workflows, process flows, and Manage EDI Maps and Connections
• Create project plans, test plans, conduct end to end testing
• Translator tool knowledge and experience
• Working with SQL Server databases
• Experience in ETL/Data Warehousing skills 
• Experience in SAFe Agile team environment driving stand up, backlog grooming, and iteration planningExperience in a customer–facing role, including comprehending business needs, solving complex problems, and capturing business requirements to convert them into technical requirements
• Experience working on Federal programs that are of high priority, visibility, and public-facing
• Experience with Agile delivery programs
• Must be able to work quickly with a high degree of accuracy with cross-functional teams
• Able to work under minimal supervision, act independently and exercise an expert level of decision-making capability
• Demonstrated ability and experience using Microsoft Office Suite including Word, PowerPoint, Excel, Visio, and Access

Education

• Bachelor of Science degree

Clearance:

• The ability to pass a Moderate Background Investigation (MBI)

Location:

• Remote, USA

Pay Range:

The pay for this position ranges from $79,240 to $92,500

The actual salary offer will carefully consider a wide range of factors, including your skills, qualifications, experience, and location.

Also, certain positions are eligible for additional forms of compensation, such as bonuses.

TISTA associates are eligible to participate in our comprehensive benefits plan! More information can be found here: https://tistatech.com/working-at-tista/