Systems Analyst

This is a fully remote position, open to applicants in United States.

📋 Description

• Manage Electronic Data Interchange (EDI) functions, encompassing COBA Crossover Process, Section 111, and Data Sharing Agreements.

• Diagnose and troubleshoot issues related to direct file transfers and COBSW.

• Deliver front-line customer support and educate stakeholders via the EDI Hotline.

• Oversee file processing between mainframe and distributed systems.

• Generate error reports and liaise with trading partners, programmers, insurers, employers, Medicare contractors, and CMS to resolve issues.

• Address stakeholder concerns within service level agreements (SLAs), responding to emails, voicemails, and work items within two business days.

• Provide EDI Hotline assistance while adhering to schedules, monitoring AUX code limits, and minimizing missed calls.

• Troubleshoot issues related to data file transmission and transaction errors, ensuring communication links and interfaces are verified.

• Manage daily workflow queues across MIRA, BCRS, ECRS, and internal tracking spreadsheets.

• Establish, document, and sustain EDI procedures while reconciling EDI transactions.

• Maintain the EDI Inquiry Problem database by resolving issues with standardized documentation.

• Conduct audits of EDI transactions and maintain EDI maps and business rules for HIPAA validation software.

• Monitor and rectify problems related to claim file transmission or content.

• Analyze claim crossover inquiries associated with eligibility files and billing.

• Collaborate with management, technical application teams, and business partners to define project specifications, timelines, and deliverables.

• Initiate and lead client meetings for ongoing and prospective projects.

• Identify new business opportunities, systems, processes, and operational enhancements.

• Build and maintain relationships with both internal and external trading partners.

• Train customers and employees on data exchange processes and systems.

• Coordinate tasks with BCRC partners to ensure EDI information is formatted correctly.

• Assist with User Acceptance Testing for system enhancements.

• Create and update educational materials for the COBSW site.

• Support customers during their transition from testing to production.

• Respond to inquiries from CMS Central Office and Regional Office.

• Perform additional EDI mission duties as assigned by management.

⛳️ Requirements

• Minimum of 5 years of relevant experience.

• Bachelor’s Degree or an equivalent combination of post-secondary education and relevant work experience.

• Experience in a Customer Support Specialist role or a similar customer service position.

• Strong analytical and research capabilities.

• Effective communication skills with all levels of management and diverse communities.

• Excellent verbal and written communication abilities.

• Proficient in PC skills, including Microsoft Office products.

• Designated workspace to facilitate remote work.

• Desired experience in technical support.

• Familiarity with Amazon Web Services (AWS) is preferred.

• Experience in researching and analyzing file layouts, particularly 837 flat files, is advantageous.

• Knowledge of Medicare Parts A, B, C, and D is beneficial.

• Understanding of health insurance concepts and/or HIPAA EDI 837 is desirable.

• Familiarity with data processing systems and hardware, especially personal computers, is preferred.

• Knowledge of Professional and Institutional file structures and guidelines is a plus.

• Understanding of NDM (Connect Direct), FTP, dedicated connections, and telecommunications software/concepts is desirable.

• Experience in maintaining trading partner accounts in a high-volume environment is beneficial.

• Working knowledge of EDI data translation/validator support, including Sterling Gentran/Ingenix Faciledi, is advantageous.

• Exceptional interpersonal and customer relationship skills are desired.

• Ability to quickly and independently learn new concepts while maintaining effective communication is preferred.

• Previous experience working remotely in a home office setting is a plus.

🏝️ Benefits

• Options for medical plans, including those with Health Savings Accounts.

• Choices for dental plans.

• Vision plan availability.

• 401(k) plan with pre-tax and post-tax contributions along with company matching.

• Flexible work weeks where feasible.

• Paid leave for vacation, sick days, personal time, holidays, parental leave, military leave, bereavement, and jury duty.

• Typically 15 days of paid leave annually.

• 10 paid holidays throughout the year.

• Up to 160 hours of paid family leave within a rolling 12-month period for eligible employees.

• Short- and long-term disability benefits.

• Life insurance coverage.

• Accidental death and dismemberment insurance.

• Personal accident insurance.

• Critical illness insurance.

• Business travel and accident insurance.

• Opportunity for remote work.

• Identity verification process utilizing biometrics and artificial intelligence.