System Operations Analyst

Job Description

Job Description

Position Summary:  

The System Operations Analyst (SOA) is responsible for overseeing the day-to-day Electronic Data Interchange (EDI) operations, ensuring the smooth flow of electronic transactions between our organization and external partners. The System Operations Analyst will play a vital role in monitoring, troubleshooting, and optimizing EDI processes to enhance operational efficiency.  Ultimately, their goal is to aid in fulfilling our mission of positively impacting the health and wellness of those we serve in our community.

Qualifications:   

• Associate degree preferred and/or two to four years of experience. 
• Knowledge of Healthcare environment desired
• Proficient in relevant computer applications such as MS Word, MS Excel, MS PowerPoint, and Epic

Essential Duties and Responsibilities:

• Processes all inbound and outbound feeds necessary to achieve positive outcomes including eligibility, claims, maximum out of pockets, health plan employer data and information sets, and any other electronic data interchange files as required
• Prepares source data for computer entry by compiling and sorting information, establishing entry priorities to enter data into the EPIC Tapestry system
• After manually or automatically uploading information, determines if any data integrity issues were found and creates/executes reports to the team leader/manager for resolution
• Assists in loading EPIC files such as Claims, Encounters, MOOP, Eligibility, 835, 837 and other files
• Performs tasks to effectively test loads as Claim, Eligibility and MOOP loads, AP Claim payment process
• Processes workflow/standard operating procedure documents by reviewing data for deficiencies, resolving discrepancies by using standard procedures or returning incomplete documents to the team leader/manager for resolution
• Ensures data loads are completed timely and accurately in EPIC Tapestry system to ensure timely claims payment
• Performs validation when necessary of critical business data details for providers found in various industry specific websites, databases, and internal documents
• Maintains data entry requirements by following pre-defined data program techniques and procedures
• Monitors CRM requests to accurately update data in the system in accordance with established guidelines
• Follows workflows and adheres to established Policy and Procedures to comply with all daily responsibilities
• Consistently meets assigned project deadlines and goals
• Protects Business Operations and organization by keeping information confidential

  This job description in no way states or implies that these are the only duties performed by the employee occupying this position.  Employees will be required to perform any other job-related duties assigned by their supervisor or management.

Skills and Abilities:   

• Accurate keyboard skills and proven ability to enter data at the required speed, and knowledge of correct spelling, grammar and punctuation
• Strong computer skills and experience working within databases
• Excellent communication skills, both written and verbal, to interact with the business in gathering requirements and presenting data from the reports
• Well-organized, action and results oriented team player with exceptional time management skills to support multiple initiatives simultaneously in a fast-paced environment with accuracy
• Ability to establish and articulate results with high attention to detail and the ability to prioritize.
• Good presentation skills with solid communication capabilities and practices, both oral and written
• Ability to ensure processes comply with HIPPA regulations

Work Schedule:

Community Care Plan is currently following a hybrid work schedule. The company reserves the right to change the work schedules based on the company needs.

Physical Demands: 

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.  While performing the duties of this job, the employee is regularly required to sit, use hands, reach with hands and arms, and talk or hear.   The employee is frequently required to stand, walk, and sit. The employee is occasionally required to stoop, kneel, crouch or crawl. The employee may occasionally lift and/or move up to 15 pounds.

  Work Environment: 

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of the job. The environment includes work inside/outside the office, travel to other offices, as well as domestic, travel.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.

We are an equal opportunity employer who recruits, employs, trains, compensates and promotes regardless of age, color, disability, ethnicity, family or marital status, gender identity or expression, language, national origin, physical and mental ability, political affiliation, race, religion, sexual orientation, socio-economic status, veteran status, and other characteristics that make our employees unique. We are committed to fostering, cultivating, and preserving a culture of diversity, equity and inclusion.

Background Screening Notice:
In compliance with Florida law, candidates selected for this position must complete a Level 2 background screening through the Florida Care Provider Background Screening Clearinghouse.

The Clearinghouse is a statewide system managed by the Agency for Health Care Administration (AHCA) and is designed to help protect children, seniors, and other vulnerable populations while streamlining the screening process for employers and applicants.

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