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: 673172

Posted On: Jan 22, 2022

Updated On: Mar 22, 2022