Identify, document and educate MTM partners on client EDI requirements
Identify, analyze and document business objectives and requirements by performing analysis and developing the necessary documentation to define, justify, launch and execute projects
Monitor, analyze, and ensure EDI compliance in the following subject areas: Member Eligibility, Encounter and Claims Data, Payment Remittance, Capitation, and Provider Data
Manage and coordinate EDI deliverables to both internal and external stakeholders including but not limited to: EDI data files, accompanying reports, and required attestations
Validate EDI solutions meet both internal and external client needs
Lead requirement gathering sessions, stakeholder interviews, group sessions, and user observations
Act as a liaison between the business customer and the technology providers, both internally and externally
Communicate relative feedback, level of effort, and return on investment to business users for project prioritization
Responsible for making improvements of processes or workflows to enhance performance
Partner with associated departments to ensure uniformity in data
Remain informed on ever changing information to ensure accuracy within business processes
Partner with EDI developers to ensure solutions meet requirements

Requirements

High School Diploma or G.E.D equivalent
Bachelor’s degree in technical or business disciplines with outlined experience, however, willing to accept equivalent field experience in lieu of degree
Minimum 3 years of EDI technical or business work experience
3+ years of SQL experience
3+ years of working HIPAA X12 Standard Transactions
3+ years’ experience in software development methodologies including Agile and scrum processes
3+ years’ experience in eliciting/documenting business requirements using interviews, group facilitation, data/workflow/system analysis and business process documentation
Previous experience collaborating with Business Users, Programmers, and Quality Assurance Testers in a corporate environment

Benefits

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools

EDISQLHIPAA X12 Standard TransactionsAgileScrumbusiness requirements documentationdata analysisworkflow analysissystem analysisbusiness process documentation

Soft Skills

communicationstakeholder managementcollaborationprocess improvementanalytical thinkingproblem-solvingfacilitationproject prioritizationeducationliaison

Certifications

High School DiplomaG.E.D equivalentBachelor’s degree