Operations Analyst – EDI

ABOUT UCARE

At UCare, we deliver high-quality health coverage and services to help members of all ages maintain and improve their health. It’s a big job that takes innovative ideas, strategic partnerships, and a commitment to doing the right thing. Above all, it takes a compassionate team that is dedicated to making a real difference in the lives of our members and our communities.

WORKING AT UCARE

Working at UCare is more than just a career; it’s a mission. A mission that defines us as professionals, unites us as an organization, and shapes how we interact with our members and each other. Our values of integrity, community, quality, flexibility, and respect permeate every aspect of our organization – from who we are and how we act, to what we do and how we do it. We owe our continued success to our employees who proudly embody our mission and values in everything they do.

OPERATIONS ANALYST – EDI

Position Description

This position is responsible to support the team by providing daily business support for EDI activities, research questions and issue resolution; maintaining implementation companion guides; supporting the development of interfaces; performing data audits to validate information exchanged with the providers; and running reports as needed. The analyst will also be responsible to collaborate with business subject matter experts to analyze and document business requirements and work with the technical analyst to decompose them to create functional specifications for development; performing gap analysis and recommending potential solutions. The EDI analyst will act as a liaison between the business, IS technical team, trading partners, and UCare’s representative for external EDI – related committees and workgroups.

· Develop and maintain trading partner requirements, and handling communications with trading partners for EDI transaction set-up, ongoing maintenance, proactively identifying issues and resolving them.

· Perform processing analysis to ensure completion and accuracy of processed data/Automate and monitor the EDI transaction processes to ensure that transactions are processed accurately and on schedule, and appropriately follow up on any errors. Audit data to validate information supplied to/from providers/ and trading partners.

· Document system requirements and oversees documentation of the EDI solution for the systems.

· Provide ongoing assistance to software developers and testers to resolve more complex defects during the development and testing process. Track and manage open EDI solution issues and plans for their resolution. As needed, develops and executes test plans and documents test results.

· Develop and maintain trading partner requirements, and handling communications with trading partners for EDI transaction set-up, ongoing maintenance, proactively identifying issues and resolving them.

· Perform processing analysis to ensure completion and accuracy of processed data/Automate and monitor the EDI transaction processes to ensure that transactions are processed accurately and on schedule, and appropriately follow up on any errors. Audit data to validate information supplied to/from providers/ and trading partners.

· Document system requirements and oversees documentation of the EDI solution for the systems.

· Provide ongoing assistance to software developers and testers to resolve more complex defects during the development and testing process. Track and manage open EDI solution issues and plans for their resolution. As needed, develops and executes test plans and documents test results.

· Collaborate with technical EDI analyst and software engineers to help create proofs of concept and alternative solutions to create, maintain and enhance business value.

· Perform team administrative duties including status reporting and ongoing client support for technical system questions and problems.

· Serve as subject matter expert for EDI transactions and processing.

· Analyze and research system problems, coordinating with vendors and other parties as necessary, and tracks them to resolution; develops, documents, and communicates alternative workarounds for system defects until system solutions can be implemented.

· Recommend process and system enhancements to improve business performance and maximize the effectiveness of available technology / Participates in the analysis of existing business process and systems recommendations/enhancements to improve business performance and maximize the effectiveness of available technology.

· Other projects and duties as assigned.

Education

Bachelor’s Degree (technical, business or science degree); demonstrated experience in managed health care may be considered in lieu of degree.

Required Experience

Three years of progressive experience with EDI, familiarity with .net and SQL. Knowledge of HIPAA/EDI X12 v5010 healthcare-related EDI file formats. Proficiency with regulatory requirements associated with HIPAA, CAQH CORE, ICD-10, and the Affordable Care Act. Experience in healthcare business processes, claims and enrollment. Familiarity with the EDI provisions of the Affordable Care Act of 2010. Familiarity with EDI translation software and concepts. Fluent with commonly used EDI concepts, best practices, and procedures within the health care industry.

Preferred Experience

Two years of experience working on Agile teams with experience in developing Epics, User Stories, Acceptance Criteria. Experience in Test Driven Development and automated unit testing. Knowledge of others Agile approaches: XP, Kanban, Crystal, Feature Driven Development (FDD).

THE UCARE DIFFERENCE

UCare is proud to be a recognized Star Tribune Top Workplace for the 7th consecutive year. As a part of our collaborative team, you’ll experience the rewards that come with helping others and seeing the positive results of your hard work. We value and respect each individual’s ideas and contributions, and give you the freedom to grow both personally and professionally. We are centrally located, and offer onsite education, equipment and wellness resources, a myriad of volunteer activities, and a number of other rewards. If you’re looking for a welcoming environment that celebrates what you have to offer, helps you build on your strengths, and gives you the opportunity to truly make a difference, we invite you to apply.

As an Equal Opportunity/Affirmative Action Employer, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.