EDI Analyst - (Menasha) in Appleton, Wisconsin For Sale
Network Health's success is rooted in its mission to enhance the life, health and wellness of the people we serve. It drives the decisions we make, including the people we choose to join our growing team. Network Health is seeking an EDI (Electronic Data Interchange) Analyst. This individual o versees Network Health Plan's Electronic Data Interchange (EDI) processes. Transmits and receives electronic data files on a daily basis. Develops, documents, and maintains EDI processes that conform to all applicable regulatory and accreditation requirements. Troubleshoots EDI processing errors and works with trading partners to resolve problems and maximize data acceptance rates. Develops test plans to ensure that new trading partners can successfully exchange data with Network Health. A qualified candidate will have a desire to work with a "values driven" organization while having the ability to communicate effectively, remain organized, and have ability to apply analytical thinking to identify and solve problems. Essential Job Duties: Transmits and receives electronic files to/from EDI trading partners on a daily basis using a variety of software communication tools. Formats data files as needed using appropriate translator software. Imports and exports data to and from Network Health's transactions. Develops, documents, and maintains processes for transmitting electronic files. Ensures processes conform to all applicable regulatory and accreditation requirements. Coordinates with other departments to ensure the efficient processing of transaction data. Maintains configuration information for EDI processing software. Maintains identification numbers and cross-reference tables needed for EDI translation. Determines appropriate logic to be used for member and provider matching. Maintains security settings. Troubleshoots EDI processing errors. Evaluates reports and raw data files to determine source of problems. Works with trading partners to resolve problems and maximize data acceptance rates. Serves as primary contact for EDI clearinghouses and other trading partners on EDI issues. Works with IS Management and legal Department on contracts and trading partner agreements. Reviews invoices from clearinghouses to ensure accuracy. Contacts new submitters for necessary information to configure system. Develops appropriate test plans to ensure that new submitters can successfully exchange EDI files with Network Health. Maintains statistics of EDI acceptance and rejections rates. Recommends process changes and new trading partner arrangements that can increase EDI acceptance rates and improve operational efficiencies. Performs other duties and responsibilties as assigned. Skills Required: Excellent communication and customer service skills. Must be able to work independently, and have excellent problem-solving abilities and team skills. Understanding of HIPAA EDI transaction standards and submission requirements. Familiarity with computer applications used to secure, transmit, and translate data. Understanding of industry practices for billing and paying healthcare claims. Working knowledge of SQL and reporting tools. Minimum Education Required : Associate degree in Information systems or related program, or equivalent experience. Minimum Related Years of Experience ( per minimum education ) Required: 3 - 5 years experience in healthcare. EDI and insurance experience preferred. Company Description: Ministry Health Care is a network of hospitals, clinics, and other health related organizations operating across the central, northern, and northeastern regions of Wisconsin and eastern Minnesota. To meet the needs of the communities we serve, we offer a complete continuum of care through acute and tertiary care hospitals, physician clinics, long-term care and assisted living facilities, home health agencies, hospices, and numerous other programs and services.
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