Systems Analyst Associate

Public Trust: None

Requisition Type: Regular

Your Impact

Own your opportunity to be on the frontlines of health innovation. Deliver for America’s health agency missions and enhance lives for hundreds of millions every day.

Job Description

General Dynamics Information Technology (GDIT) is seeking a Systems Analyst Associate to support our client. In this role, you will be administering all aspects of Electronic Data Interchange (EDI) activities including Coordination of Benefits Agreement (COBA) Crossover Process, Section 111, and Data Sharing Agreements with employers. You will also be responsible for troubleshooting and diagnosing issues with direct file transfer and issues experienced with the Coordination of Benefits Secure Website (COBSW). Additionally, you be responsible for the front-line customer service support and education with Stakeholders via the EDI Hotline, requiring strict adherence to call center metrics.

This is a remote opportunity!

• Monitor the processing of files between mainframe and distributed system including compiling error reports and communicating with the Trading Partners, programmers, Insurers, Employers, Medicare contractors and CMS to resolve

• Interact directly with stakeholders to resolve issues within strict Service Level Agreements (SLAs), including returning all emails, voicemails, and work items within 2 business days.

• Provide front-line support on the EDI Hotline, maintaining strict Schedule Adherence, monitoring AUX code limits, and minimizing missed calls.

• Work independently on assigned business partners with a minimum of supervision

• Troubleshooting and facilitating the resolution of any identified data file transmission and transaction errors including verification that all communication links and interfaces are working correctly and communicating appropriately

• Manage daily workflow queues across multiple systems, including MIRA, BCRS, ECRS, and maintaining internal tracking spreadsheets.

• Working with management to establish, document and maintain EDI procedures by identifying errors and taking corrective action, reconciling EDI transaction through coordination of information with internal and external customers, Accounting Department, IT Department and external vendors to maintain EDI integrity

• Overseeing and maintain the EDI Inquiry Problem database including the evaluation of problems or issues through to resolution by maintaining highly detailed, standardized documentation (who, what, action performed, and outcome) on all interactions.

• Conducting regular audits of EDI transactions to determine accuracy and areas for improvement and maintaining EDI maps and business rules for HIPAA validation software

• Monitoring the daily receipts and processing of claim files from Medicare contractors along with troubleshooting and resolving data transmission or content problems

• Performing analysis based on claim crossover inquiries related to eligibility files and billing.

• Interfacing with and/or lead management and technical application teams and both internal and external business partners to define project specifications, time-lines and deliverables through primary account ownership, including proactively initiating, leading, and facilitating client meetings for ongoing and prospective projects

• Identifying, new business opportunities, new systems and processes and possible improvements that can be made to ongoing operations to present to management

• Identifying, establishing and maintaining business relationships with internal and external trading partners and business partners

• Training customers and internal employees on the data exchange processes available and the data exchange systems

• Performing other duties in support of the organization/EDI mission as directed by management

• Coordinate tasks with our BCRC partners to ensure that all EDI information is correctly formatted to enable us to provide an accurate Response File back to complete the transaction

• Assist in User Acceptance Testing of system enhancements prior to being moved into production

• Assist in the development and updating of educational material for the COBSW Site for all EDI Activities

• Closely work with our external customers to ensure they have a smooth transition from testing to production

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

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

• Experience as a Customer Support Specialist or similar CS role

• Strong analytical and research skills

• Ability to communicate effectively with all levels of management and communities

• Excellent verbal and written communication skills

• PC skills including working knowledge and proficiency with Microsoft Office products

• Designated office space in order to work from home

• Technical support experience

• Proficiency in Amazon Web Services (AWS)

• Experience researching and analyzing file layouts, specifically 837 flat files

• Knowledge of health insurance concepts such as Medicare Part A, B, C and D

• Knowledge of health insurance concepts and/or experience in HIPAA EDI 837

• Knowledge of data processing systems and hardware particularly personal computers

• Knowledge of Professional and Institutional files structures and guidelines

• Knowledge of telecommunication data delivery methods and telecommunication software and concepts such as NDM (Connect Direct) and), FTP and dedicated connections

• Experience in the implementation of maintenance of trading partner accounts in a high-volume, high-paced operation using flexibility in terms of managing many accounts with unique requirements

• Working knowledge of EDI data translation/validator support, i.e. Sterling Gentran/Ingenix Faciledi a plus

• Excellent interpersonal and customer relationship skills with the ability to work in a very fast paced environment

• Ability to learn new concepts quickly and independently while maintaining effective communications with other team members

• Past experience working remotely in an at-home office

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Work Requirements

Years of Experience

5 + years of related experience

* may vary based on technical training, certification(s), or degree

Certification

Travel Required

None