Senior Data Analyst Electronic Data Interchange

The pay range above represents the minimum and maximum rate for this position in California. Factors that may be used to determine where newly hired employees will be placed in the pay range include the employee specific skills and qualifications, relevant years of experience and comparison to other employees already in this role. Most often, a newly hired employee will be placed below the midpoint of the range. Salary range will vary for remote positions outside of California and future increases will be based on the pay band for the city and state you reside in.

Work Culture:

GCHP strives to create an inclusive, highly collaborative work culture where our people are empowered to grow and thrive.  This philosophy enables us to create the health plan of the future and do our best work – Together.

GCHP promotes a flexible work environment. Employees may work from a home location or in the GCHP office for all or part of their regular workweek (see disclaimer).

GCHP’s focuses on 5 Core Values in the workplace:

•    Integrity

•    Accountability

•    Collaboration

•    Trust 

•    Respect

Disclaimers:

•    Flexible work schedule is based on job duties, department, organization, or business need.

•    Gold Coast Health Plan will not sponsor applicants for work visas.

POSITION SUMMARY

Senior Data Analyst/EDI is responsible for managing and analyzing electronic data interchange (EDI) transactions, ensuring accurate data flow between the organization and external partners, including providers, payers, and vendors. This role involves troubleshooting, maintaining compliance with healthcare industry standards, and leveraging data insights to support decision-making and operational efficiency.

Reasonable Accommodations Statement

To accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions.

Amount of Travel Required: 5-10%

ESSENTIAL FUNCTIONS

Job Function & Responsibilities

The following duties are expected to be performed for both the Medicare, Medicaid and any new business units:

•    Performs regular system monitoring to verify the integrity, health and availability of all systems and key processes, reviewing application and system logs and ensuring completion of scheduled jobs 

•    Responsible for ensuring that data received from external and internal parties (such as our Clients and Vendor partners) are successfully ingested and available for processing in our transactional systems, while also ensuring that file extracts for external and internal business partners are produced and delivered on the agreed upon schedule.

•    Assists in the development and optimization of file exchange process monitoring tools and processes

•    Ownership over the version of all EDI mapping documentation

•    Participates in Data Governance Council meetings

•    Oversee the integration of various data sources and ensure seamless data flow across different systems within the organization

•    Partner with Data Engineering and Data Governance on the accuracy of the data models and the outputs to optimize operational performance and achieve financial targets

•    Provide ad-hoc analysis to support L2 inquiry requests

•    Assist in managing EDI projects, system upgrades, implementations, and enhancements, ensuring successful completion within agreed timelines and budgets

•    Partners with Vendors on issue resolution

MINIMUM QUALIFICATIONS

Education & Experience: 

•    BA/BS in MIS, statistics, computer science, mathematics, information management, business, or a related field Preferred

•    4+ years of experience of performing data analysis and reporting development

•    4+ years of experience with writing SQL queries and stored procedures with relational databases

•    Experienced with supporting healthcare business transactions for Medicare and Medicaid business

•    IT Service desk experience

•    Comfortable working with large raw data files (Csv, Txt , EDI) is necessary (editing, manipulating, searching.

•    Intermediate level of proficiency in MS packages including ADO

•    Ability to plan, implement, test, and troubleshoot complex technology, software, and system solutions

•    Understanding of statistical tools

•    Passion for problem-solving and customer service

•    Experience with Health Insurance or Health Care related data X12 EDI, FHIR, and other structured JSON, XML, or proprietary formats

•    Strong ability to translate insights from the data

Equivalent In lieu of degree:   

Will accept experience in any combination of academic education, professional training, or work experience, which demonstrates the ability to perform the duties of the position.

4 -5 years of EDI experience  must be added in lieu of a bachelor’s degree.

KNOWLEDGE, SKILLS & ABILITIES

Preferred Qualifications:    

Additional experience or related experience in managed care, Medi-Cal, Medicare, leadership experience, etc. • Proven experience working as an EDI Analyst or in a similar role.

• Experienced with WEDI SNP Editing

• Proficient experience with FHIR formats and tooling

• Strong knowledge of EDI protocols and standards, such as ANSI X12, EDIFACT, XML, and AS2.

• Proficient in EDI mapping and translation tools, such as Gentran, Sterling Integrator, or similar software.

• Excellent analytical and problem-solving skills, with the ability to identify and troubleshoot issues related to data communication and system integration.

• Solid understanding of business processes and workflows in the healthcare industry

• Strong attention to detail and accuracy, with the ability to handle large volumes of data and ensure data integrity

• Excellent communication and interpersonal skills, with the ability to work effectively with cross-functional teams and external partners.

• In-depth knowledge of EDI protocols, standards, and best practices

• Experience in working with EDI VANs (Value-Added Networks) 

• Knowledge of industry-specific EDI documents and transactions, such as 837, 835, 834, 820, 274, 837 encounters, and 27x series and their corresponding responses

• Tableau, Power BI

• Excellent Problem-solving skills

Technology & Software Skills: Advanced computer skills in MS Office products.

Certifications & Licenses: A valid and current Driver's License, Auto Insurance, and professional licensures required

Competency Statements

•    Management Skills - Ability to organize and direct oneself and effectively supervise others.

•    Business Acumen - Ability to grasp and understand business concepts and issues.

•    Decision Making - Ability to make critical decisions while following company procedures.

•    Goal Oriented - Ability to focus on a goal and obtain a pre-determined result.

•    Interpersonal - Ability to get along well with a variety of personalities and individuals.

•    Diversity Oriented - Ability to work effectively with people regardless of their age, gender, race, ethnicity, religion, or job type.

•    Time Management - Ability to utilize the available time to organize and complete work within given deadlines.

•    Consensus Building - Ability to bring about group solidarity to achieve a goal.

•    Relationship Building - Ability to effectively build relationships with customers and co-workers.

•    Presentation Skills - Ability to effectively present information publicly.

•    Delegating Responsibility - Ability to allocate authority and/or task responsibility to appropriate people.

•    Leadership - Ability to influence others to perform their jobs effectively and to be responsible for making decisions.

•    Strategic Planning - Ability to develop a vision for the future and create a culture in which the long-range goals can be achieved.

•    Ethical - Ability to demonstrate conduct conforming to a set of values and accepted standards.

•    Judgment - The ability to formulate a sound decision using the available information.

•    Communication, Oral - Ability to communicate effectively with others using the spoken word.  

•    Communication, Written - Ability to communicate in writing clearly and concisely.  

•    Problem Solving - Ability to find a solution for or to deal proactively with work-related problems.