TalentAlly
Systems Analyst-EDI Management - SHP Finance - Telecommuter - Day Shift - Full T
TalentAlly, San Diego, California, United States, 92189
Systems Analyst-EDI Management - SHP Finance - Telecommuter - Day Shift - Full Time
Shift Start Time:
8 AM Shift End Time:
5 PM AWS Hours Requirement:
8/40 - 8 Hour Shift Weekend Requirements:
As Needed On-Call Required:
No Hourly Pay Range:
$42,790 - $55,210 - $61,840
What You Will Do:
Under the direction of the Manager of EDI Management, the Systems Analyst-EDI Mgmt will use technical and analytic skills to complete monitoring, reviewing, developing, triaging, scheduling and mapping inbound and outbound data files for Sharp Health Plan. The role works with general Health Plan operational data sets including eligibility, claims, provider, billing, capitation, financial and structural, streamlining processes, creating efficiencies and completing development within the file management space.
Required Qualifications:
H.S. Diploma or Equivalent
2 Years experience in a health care and/or health plan organization.
Experience with data communications standards, data processing, and system configurations.
Experience analyzing complex issues and/or requests to provide effective solutions with the ability to identify root cause, communicate options and propose solutions.
Preferred Qualifications:
Associate's Degree
2 Years Direct experience in project planning and system implementation.
Experience as systems analyst within a large Health Plan.
Essential Functions:
File Management Systems Analyst-EDI Mgmt will be familiar with tools such as Snowflake and SQL to create data files. Fluency in database tools is required. Develop new files based on specifications, utilize Epic Tapestry reporting toolset, and provide expertise on file structure.
Quality Assurance: Ensure files are checked for quality and measured against reliable sources; develop and implement quality checks.
Participates in other duties as assigned, special projects, audits, etc.
Data Exchange: Configure, oversee and monitor SFTP routing rules, report on abnormalities, work with external partners on data quality concerns, familiar with EDI transactions and health care file sets (837, 834, 835, etc.).
Knowledge, Skills, And Abilities:
Professional level knowledge of health plan operations, software configuration, enrollment and claim file processing, trading partner management, and data processing environments.
Familiarity with data communications standards and system configuration.
Working knowledge of hospital, physician, and health plan operations.
Strong analytical and problem solving skills; ability to collect and conduct interactive data analysis.
Extensive knowledge of IDX, Facets, QNXT, HealthEdge, HPS, and other administrative systems.
Excellent written and verbal communication skills, including interaction with senior management.
Ability to apply independent decision-making skills and work well under tight deadlines and multiple priorities.
Sharp HealthCare is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, or any other protected class.
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8 AM Shift End Time:
5 PM AWS Hours Requirement:
8/40 - 8 Hour Shift Weekend Requirements:
As Needed On-Call Required:
No Hourly Pay Range:
$42,790 - $55,210 - $61,840
What You Will Do:
Under the direction of the Manager of EDI Management, the Systems Analyst-EDI Mgmt will use technical and analytic skills to complete monitoring, reviewing, developing, triaging, scheduling and mapping inbound and outbound data files for Sharp Health Plan. The role works with general Health Plan operational data sets including eligibility, claims, provider, billing, capitation, financial and structural, streamlining processes, creating efficiencies and completing development within the file management space.
Required Qualifications:
H.S. Diploma or Equivalent
2 Years experience in a health care and/or health plan organization.
Experience with data communications standards, data processing, and system configurations.
Experience analyzing complex issues and/or requests to provide effective solutions with the ability to identify root cause, communicate options and propose solutions.
Preferred Qualifications:
Associate's Degree
2 Years Direct experience in project planning and system implementation.
Experience as systems analyst within a large Health Plan.
Essential Functions:
File Management Systems Analyst-EDI Mgmt will be familiar with tools such as Snowflake and SQL to create data files. Fluency in database tools is required. Develop new files based on specifications, utilize Epic Tapestry reporting toolset, and provide expertise on file structure.
Quality Assurance: Ensure files are checked for quality and measured against reliable sources; develop and implement quality checks.
Participates in other duties as assigned, special projects, audits, etc.
Data Exchange: Configure, oversee and monitor SFTP routing rules, report on abnormalities, work with external partners on data quality concerns, familiar with EDI transactions and health care file sets (837, 834, 835, etc.).
Knowledge, Skills, And Abilities:
Professional level knowledge of health plan operations, software configuration, enrollment and claim file processing, trading partner management, and data processing environments.
Familiarity with data communications standards and system configuration.
Working knowledge of hospital, physician, and health plan operations.
Strong analytical and problem solving skills; ability to collect and conduct interactive data analysis.
Extensive knowledge of IDX, Facets, QNXT, HealthEdge, HPS, and other administrative systems.
Excellent written and verbal communication skills, including interaction with senior management.
Ability to apply independent decision-making skills and work well under tight deadlines and multiple priorities.
Sharp HealthCare is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, or any other protected class.
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