Senior Healthcare HIPAA EDI Data Analyst

Overview:

TISTA Science and Technology is seeking a Senior Healthcare HIPAA EDI Data Analyst who will work as a subject matter expert working with EDI data and business processes. 

TISTA associates enjoy above Industry Healthcare Benefits, Remote Working Options, Paid Time Off, Training/Certification opportunities, Healthcare Savings Account & Flexible Savings Account, Paid Life Insurance, Short-term & Long-term Disability, 401K Match, Tuition Reimbursement, Employee Assistance Program, Paid Holidays, Military Leave, and much more!

Stay Connected:

Follow us on LinkedIn for updates on this job and other exciting opportunities.

• Provides subject-matter expertise on available data and quantitative solutions
• Identifies the best combination of available data, analytical methods, and presentation for analytic solutions
• Analyzes business data for actionable intelligence
• Evaluates data-centric tasks to determine the appropriate analytic approaches
• Coordinates work of data analysts, providing subject-matter expertise and guidance
• Performs data-mining, modeling and develop customized algorithms to solve analytical problems with incomplete data sets
• Develops proper algorithms in order to establish the desired linkage between the existing data in the warehouse and the new data set
• Tracks data lineage of benefits to cost, eligibility and enrollment data, provider to beneficiary, and program to utilization
• Collaborates with product management and engineering team to understand needs and devise possible solutions
• Keeps up-to-date with latest technology trends

• Oversee Comprehensive EDI Transactions:
  Manage and ensure the smooth execution of all HIPAA-compliant EDI transactions, including:
  • 837: Claims (Institutional, Professional, Dental)
  • 835: Payment and Remittance Advice
  • 270/271: Eligibility and Benefits Inquiry/Response
  • 276/277: Claim Status Inquiry/Response
  • 278: Referrals and Authorizations
  • 834: Benefit Enrollment
  • 820: Premium Payments

• Optimize Transaction Lifecycles:
  Analyze the entire EDI transaction lifecycle to identify bottlenecks, errors, and inefficiencies, implementing data-driven solutions to streamline processes and improve performance.

• Error Resolution and Collaboration:
  Lead initiatives to address and resolve claim rejections, eligibility errors, and payment discrepancies. Collaborate with providers, payers, and clearinghouses to maintain seamless data exchange and compliance.

• Technical Expertise:
  • Possess extensive experience with HIPAA-compliant EDI transactions and ASC X12 standards.
  • Leverage proficiency in EDI tools, mapping technologies, and data transformation platforms.
  • Demonstrate strong knowledge of healthcare coding standards, including ICD-10, CPT, HCPCS, and NDC.

• Advanced Data Analysis:
  • Troubleshoot complex EDI issues using tools such as SQL, mapping software, and integration platforms.
  • Optimize database queries and develop detailed reports to provide actionable insights on EDI data trends and system performance.

• Leadership and Process Improvement:
  Act as the primary point of contact for all EDI-related issues, ensuring timely resolution and fostering continuous process enhancements to improve efficiency and compliance.

• Cross-Functional Collaboration:
  Partner with IT, compliance, operations, and other stakeholders to design, implement, and refine EDI solutions aligned with organizational objectives.

• Mentorship and Team Development:
  Provide mentorship to junior analysts, sharing knowledge and expertise to foster team development and ensure consistency in EDI operations.

• 5 yrs relevant experience in data-mining, modeling and EDI based transactions
• Experience mapping and supporting EDI based transactions i.e., 837, 835, 270/271, 276/277, 278, 834, and 820
• Knowledge of EDI, X12/EDIFACT standards and practices, and EDI translators
• EDI experience (setup, mapping, testing, processing, troubleshooting)
• Proficient in EDI layouts (loops, segments, data elements)
• Perform EDI onboarding and testing with applicable third-party providers
• Create workflows, process flows, and Manage EDI Maps and Connections
• Create project plans, test plans, conduct end to end testing
• Translator tool knowledge and experience
• Working with SQL Server databases
• Experience in ETL/Data Warehousing skills 
• Experience in SAFe Agile team environment driving stand up, backlog grooming, and iteration planningExperience in a customer–facing role, including comprehending business needs, solving complex problems, and capturing business requirements to convert them into technical requirements
• Experience working on Federal programs that are of high priority, visibility, and public-facing
• Experience with Agile delivery programs
• Must be able to work quickly with a high degree of accuracy with cross-functional teams
• Able to work under minimal supervision, act independently and exercise an expert level of decision-making capability
• Demonstrated ability and experience using Microsoft Office Suite including Word, PowerPoint, Excel, Visio, and Access

Education

• Bachelor of Science degree

Clearance:

• The ability to pass a Moderate Background Investigation (MBI)

Location:

• Remote, USA