Business Analyst -EDI/ Healthcare Specialist

at Signature Performance, Inc. in Portland, Maine, United States

Job Description

This is a remote based position. Applicants can be located nationwide








Job Description



Business Analyst -EDI/ Healthcare Specialist

Who We Are:

Signature Performance is working hard at lowering healthcare administrative costs for federal government agencies, payers, and providers. At Signature, our mission is to improve the health of our clients' business and making the lives of the people we work with better. We do that by leading with our values of Passion, Courage, Integrity and Respect in all interactions.

What We Offer:

Signature believes in fully developing each one of our Associates. We deliver a performance-driven atmosphere with competitive pay and bonus structure, world-class training and development classes, resources, and events, an award-winning culture to thrive in, and so much more.

Tuition Assistance Program

401(k) program with employer contributions

Comprehensive health insurance

Competitive Paid Time Off for Sick and Vacation Time

No-cost annual flu shots

A hybrid work-from-home and/or on-campus work plan

Job Description:

The Business Analyst EDI / Healthcare Specialist designs, implements, supports, and validates Provider Network (Physicians, Clinics, Pharmacies, etc.) and Client pricing constructs. This position includes monitoring of subscriber data feeds and related loads to assure systemic risks are identified and corrected, and audit and analysis of automated provider and client related pricing architecture and algorithms.

Success in this position includes assisting in the growth and maintenance of our software solutions by researching industry changes and data sets, analyzing data trends, identifying areas of opportunity, and aiding in the implementation of these enhancements. Ideal candidates should have a naturally analytical way of thinking, be able to quantitatively and qualitatively analyze information, be process oriented, and enjoy research and team collaborations.

The ideal candidate will demonstrate strong technical skills, will be familiar with the healthcare and health insurance industry, and will have experience interpreting volumes of technical information to define requirements for use during gap analysis and technical solution design.

Basic Qualifications:

Bachelor's degree or higher in business, healthcare administration, information systems, computer science, finance, accounting, mathematics, or a related field of study

Minimum of two (2) years of experience in business analysis including requirements gathering and specification documentation

Expertise in performing gap analysis, issue analysis, root cause assessment, and resolution planning

Understanding of professional and institutional claims processing and adjudication

1+ years of experience with HIPAA standards and regulatory guidelines and Electronic Data Interchange (EDI) transactions

Demonstrated knowledge of EDI document types such as 837, 277CA, 834, 835, TA1, 999, 820, NCPDPD.0

Preferred Qualifications:

Strong planning, organizational, and time management skills

Superior analytical and conceptual thinking skills

Excellent verbal and written communication

Excellent documentation skills

Experience creating detailed reports and giving presentation

Ability to influence stakeholders and work closely with them to determine acceptable solutions

Competency in Microsoft applications including Word, Excel, and Outlook

Familiarity with relational databases (SQL)

Knowledge of Atlassian Jira and Confluence a plus


Work closely with Operations team members, inter-departmental teams, clients, and managerial staff to evaluate business processes, anticipate requirements, uncover areas for improvement, and develop and implement optimization strategies

Stay informed on the latest medical billing processes and guidelines to identify claim editing, fee schedule, and systematic changes for implementation

Adapt policy-related documentation to requirements and perform refinement analysis to ensure solutions meet business needs

Conduct meetings and presentations to gather critical information, share ideas and findings, and effectively communicate insights and plans to stakeholders, cross-functional team members, and management

Perform system integration and user acceptance testing

Assist in managing projects, developing project plans, and monitoring performance to ensure initiatives are prioritized based on business needs and requirements and deliverables are on track for timely completion of projects

Update, implement, and maintain procedures

Other duties as required

Additional Information:

Applicants must be legally authorized to work in the United States. Verification of employment eligibility will be required at the time of hire. Visa sponsorship is not available for this position.

Certain positions may be subject to... For full info follow application link.


Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled

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Job Posting: 642805

Posted On: Nov 20, 2021

Updated On: Dec 26, 2021