EDI Analyst (Remote)

Job Description:

• The EDI Analyst at Evolent will serve as a key technical expert to analyze, monitor and remediate EDI X12 Transaction data issues, working with tools such as but not limited to the following: Edifecs Healthcare Suite, Edifecs Transaction Manager, Edifecs Specbuilder, SQL, PowerBI, Microsoft suite/tools (e.g. Office, PowerBI, Teams), Atlassian products (e.g. Confluence, JIRA) and several internal built applications etc. Continual focus working on developing process optimization solutions to better meet the EDI Gateway and organizational needs.

Collaboration Opportunities:

• This position serves as a technical operational point-of-contact for the mentioned functional areas and collaborating with several other teams and/or departments to further operationalize tasks which may require building new processes, solution, documentation etc. along with communicating vital information to key stakeholders related to status of monitored processes. Assisting with Tier 2 and Tier 3 internal support teams to remediate complex data issues.

What You Will Be Doing:

1. Monitor, Execute and Remediation of Daily EDI Gateway Operational Processes related to enterprise-wide production interfaces with continuous focus on process improvement.
2. EDI analysis expertise on 278 Authorization Response-Request , 837 Claims, 835 Payments corrections required with good understanding of X12 EDI Data exchanges like 278 Auth files837, 835, 270, 271, 276, 277, 999 and 834 Enrollment
3. Working on data issues or other initiatives related to both Data Operations and Electronic Data Interchange (EDI) focus areas and Tickets triage supporting escalation on EDI transactions.
4. Assisting other teams and/or departments to help operationalize tasks (e.g. defining procedures & creating SOPs) that may require additional support not currently present.
5. Communicating vital information with internal and external stakeholders related to daily operational tasks and/or status of monitored processes using PowerBI/Edifecs TM.
6. Monitor various client inbound & outbound EDI data file extract creations and remediate failures in Edifecs TM as they arise along with update operational process tickets and request status updates to processes as applicable.
7. Coordinate multiteam faceted processes within Evolent business units and create process documentation in Confluence for other team members to reference for future trainings or new hire.

Qualifications Required and Preferred:

1. Bachelor's degree or equivalent combination of education and experience
2. 1 or more years of experience with EDI Data exchanges like 278 Auth, 837, 835, 270, 271, 276, 277, 999 and 834 Enrollment, ICD 10, HCPCS codes fundamentals and advanced skills (e.g. Claims correction, 835 Payment corrections, troubleshooting EDI errors)
3. Substantial knowledge of Claims, Authorization and Eligibility and Claims status information along with Microsoft Suite applications (e.g. Word, Excel) and their functions
4. Strong interpersonal and communication skills, with experience working directly with internal and external stakeholders
5. Strong ability to apply problem solving and critical thinking skills with experience succeeding in ambiguous situations and solution design/implementation
6. Knowledge of Healthcare Standards and CMS Rules and regulations is preferred
7. Experience developing, refining and documenting business related SOPs with minimal oversight is preferred

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