Note: The job is a remote job and is open to candidates in USA. Optum is a global organization that uses technology to connect people with care, pharmacy benefits, data, and resources to improve health outcomes. The Senior EDI 278 Solutions Analyst leads end-to-end trading partner integrations between Medical Management and claims systems, ensuring seamless authorization data exchange. The role monitors and troubleshoots EDI processing, supports mapping and testing, performs data analysis, and develops documentation and reports for healthcare authorization transactions.
Responsibilities
- Monitor Daily EDI Transaction Processing
- Troubleshoot and resolve any EDI processing issues
- Implementation Team Resource for EDI Mapping, Validation and Testing as required
- Prepare and update program documentation, job aides, and other artifacts as requested
- Scheduled and ad hoc auditing of various systems and databases to support prior authorization transactions
- Process review, data analysis and measurement for various programs related to prior authorizations, claims and member eligibility
- Create process and data flow diagrams for the various programs/projects as assigned
- Preparation of reports as needed by management
- Identification and communication of processing issues to leadership
- Prepares and coordinates presentations, training, etc; used as an educational resource
- Implementation of new technologies and processes (includes testing and follow up)
- May involve some interfacing with clients, managed care customers, IT resources and others when needed
- Assignment of special projects as needed
Skills
- 5+ years of experience in each of the following:
- Experience within the healthcare data environment - eligibility, provider, claims, etc
- Experience with data mapping and workflow documentation
- Healthcare EDI Transaction Knowledge and Expertise
- Specific EDI X12 ANSI 278 Transaction Expertise
- EDI transaction mapping experience
- EDI Production Support and Maintenance Experience including editing and correcting EDI 278N X12 package data for resubmission
- EDI testing and validation experience
- Healthcare IT MMS (Medical Management Systems) experience
- Experience with SQL (manipulating data and queries) - Relational databases like MySQL, MS SQL, DB2
- Experience using Microsoft Word (creating and editing documents), Microsoft Outlook (email and calendar), Microsoft Excel (pivot tables, formulas (vlookup, xlookup, match, etc..) and Microsoft Visio (process/data flow diagrams)
- Experience using Microsoft Viso (creating and editing documents) to illustrate process or data flow diagrams
- Solid organization skills and attention to detail
- Excellent communication skills, both verbal and written, with the ability to interact with various levels of resources internally and externally
- Required to have a dedicated work area established that is separated from other living areas and provides information privacy
- Ability to keep all company sensitive documents secure (if applicable)
- Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service
- Experience building both EDI 278 real-time and batch mode integration services
- Experience with ETL (Extract Transfer Load) File Management and Archive Processes
- Experience working with cloud-based solutions and services
- Knowledgeable about claims billing practices and process management concepts - this may include knowledge of CPT coding or reimbursement processes, 3rd party provider enrollments, claims submissions, EDI and HIPAA transactions and/or accounts receivables
- Demonstrated ability to write clear technical and functional specs for authorization data integration services
Benefits
- Flexibility to work remotely from anywhere within the U.S., subject to office requirements for hires in the Minneapolis or Washington, D.C. area.
- Comprehensive benefits package, subject to eligibility requirements.
- Incentive and recognition programs, subject to eligibility requirements.
- Equity stock purchase, subject to eligibility requirements.
- 401k contribution, subject to eligibility requirements.
- Career development opportunities.
Company Overview
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