Electronic Data Interchange Analyst IV
Kern Family Health Care, 2900 Buck Owens Blvd., Bakersfield, California, United States of America Req #1657
We appreciate your interest in our organization and assure you that we are sincerely interested in your qualifications. A clear understanding of your background and work history will help us potentially place you in a position that meets your objectives and those of the organization. Qualified applicants are considered for positions without regard to race, color, religion, sex (including pregnancy, childbirth and breastfeeding, or any related medical conditions), national origin, ancestry, age, marital or veteran status, sexual orientation, gender identity, genetic information, gender expression, military status, or the presence of a non-job related medical condition or disability (mental or physical).
Our Mission.. Kern Health Systems is dedicated to improving the health status of our members through an integrated managed health care delivery system.
This position is responsible for managing complex/custom data processing, creating advanced procedures and systems, providing detailed technical analytics for complex automated process improvement projects, designs logical workflow applications, and manages the core system for the company. The position interfaces and represents the business to the technical teams, and understands all aspects of technical application development and architecture; electronic data interchange (EDI) design and implementation, and core system operations and functionality.
The EDI Analyst IV elicits highly complex/custom business requirements through group meetings, interviews, observation, and/or existing systems, and business or policy documentation. This role independently mentors and contributes to the EDI team with complex and comprehensive documentation of the technical requirements or systems modifications in a format that facilitates a business and technical communication and understanding amongst the business department or individuals. The EDI Analyst IV must have the ability to independently analyze or mine data, draw sound conclusions, and is able to interpret and follow detailed and precise written and oral instructions such as checklists, process diagrams, and policy. The EDI Analyst IV will lead communications and facilitation efforts to present the documented findings and results from an analytical engagement. The position will be required to lead, work with, and mentor people of various professional, vocational, and educational backgrounds.
Essential Duties and Responsibilities:
- Must exhibit a mastery of the American National Standards Institute (ANSI) formats that govern healthcare Electronic Data Interchange (EDI).
- Must have at least four (4) years of experience developing and maintaining Healthcare EDI X12N transactions, including batch and real-time formats such as: 837I/837P, 274, 834, 835, 270/271.
- Requires at least four (4) years of Edifecs hands-on experience with Healthcare EDI X12N transactions, including analytics, mapping, developing, testing and deployment.
- Independently works with Executives, Management, Staff, or Business analysts to identify, document, and redesign complex business concepts or processing conflicts.
- Demonstrates a working knowledge of: Edifecs: Architecture, SpecBuilder, Enterprise Application Manager, and Transaction Management, including Trading Partner Manager, and deployment procedures.
- Mastery experience with HL-7 and NCPDP File Formats, QNXT Healthcare Core Systems, including knowledge of QNXT EDI Manager and QNXT Connect (MS BizTalk).
- Must possess advanced, working knowledge of SDLC (Software Development Life Cycle) and Agile Scrum Methodologies.
- Demonstrates the ability to formulate and maintain structure query language (SQL) queries for analytical data mining, software development, TFS, Stored Procedures, ETL, and business reporting and comprehend various programming languages.
- Possesses a keen attention to detail and perform excellent analytical and problem-solving skills.
- Exemplifies excellent organizational, written and verbal communication skills and the ability to interact professionally with a diverse group, executives, managers, and subject matter experts.
- Must convey outstanding listening and interpersonal skills and have the ability to effectively prioritize and execute tasks in a high-pressure environment and support strong customer service orientation.
- Must exhibit mastery experience in a team-oriented, collaborative environment as a self-starter with able to work effectively with minimal direct supervision.
- Leads and mentors in technical areas and independently provide knowledge and documentation exchange to educate team members in Analytical roles in support of team redundancy.
- Provides formal user education with software productivity and technical tools such as SSRS, SSIS, SharePoint, Microsoft Office, Visio, Team Foundation Server, or automation tools to document business and technical process requirements related to a technology system. Experience with Tableau preferred.
- Has the ability to independently create technical processing to promote automation to perform repetitive or analytical tasks within productivity software.
- Comprehends, analyzes, and documents business or process requirements using personal interviews, document analysis, meetings, surveys, process documents, or actual scenarios.
- May assume the duties of a Project Manager for medium to large sized projects using standard PMBOK processes to identify scope, requirements, resources, and stakeholders using standard analysis techniques.
- Analyzes and documents functional business environments that facilitate work throughout the company.
- Develops complex business requirements and specifications through internal and external research to complete technical analysis, and articulate and formally present research to various skill levels.
- Leads business meetings leveraging the Agile process to assist business units in the “What” session to ensure the creation and documentation of stories and acceptance criteria.
- Provides and may lead technical interpretation to other technical teams in the Agile “How” session to understand technical requirements related to the business stories and acceptance criteria.
- Effectively communicates and collaborate with internal and external customers in support of analytics or problem resolution.
- Successfully engages in multiple complex initiatives simultaneously.
- Recommends reconciliation points necessary after a comprehensive process or data analytics engagement to mitigate/resolve present and future reconciliation conflicts.
- Has limited skills in the capacity of other departmental technologies, resources and roles in order to provide detailed analytics in everyday communications.
- Comprehends and implement system configuration changes of the managed care core system software to process data transactions for business functions such as eligibility, claims, authorizations, and case management.
- Mentors and leads in the creations of testing plans that are used in the testing and implementation of software systems used by the organization.
- Understands medical terminology to include ICD, CPT, and HCPCS coding systems related to encounters and 837s.
- Oversees, identify, and create process checklists, for self and other analysts, which will be used to process Kern Health Systems (KHS) programs and applications to support departmental activities.
Bachelor’s degree in Computer Science, Mathematics, or related field and eight (8) years progressive experience in an EDI Analyst capacity or similar Analytical position for a medium to large organization with a structured IT department preferably in healthcare.
Twelve (12) years progressive experience in an EDI Analyst capacity or similar Analytical position for a medium to large organization with a structured IT department preferably in healthcare.
Experience may be substituted on a year by year basis.
Position is suited for a senior-level to advanced career analytics or technical person.
The incumbent must have basic technical skills that come from a Degree in Information Systems or 8-10 years of general analytical experience.
We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis.