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EDI Analyst, Senior

Company: Blue Shield of CA
Location: Lodi
Posted on: January 17, 2020

Job Description:

At Blue Shield of California we are parents, leader, students, visionaries, heroes, and providers. Everyday we come together striving to fulfill our mission, to ensure all Californians have access to high-quality health care at a sustainably affordable price. For more than 80 years, Blue Shield of California has been dedicated to transforming health care by making it more accessible, cost-effective, and customer-centric. We are a not-for-profit, independent member of the Blue Cross Blue Shield Association with 6,800 employees, more than $20 billion in annual revenue and 4.3 million members. The company has contributed more than $500 million to Blue Shield of California Foundation since 2002 to have a positive impact on California communities. Blue Shield of California is headquartered in Oakland, California with 18 additional locations including Sacramento, Los Angeles, and San Diego. Were excited to share Blue Shield of California has received awards and recognition for LGBT diversity, quality improvement, most influential women in corporate America, Bay Areas top companies in volunteering & giving, and one of the worlds most ethical companies. Here at Blue Shield of California, were striving to make a positive change across our industry and the communities we live in Join us! EDI ANLAYLST, SENIOR

ESSENTIAL RESPONSIBILITIES:

* Provides analysis, support and guidance to both internal and external customers on moderate to complex electronic data transfers covering enrollment, claims, billing statements and payments.

* Conducts routine data analysis, needs assessments, and cost/benefit analysis to align information technology solutions with business initiatives.

* Formulates and defines routine to complex systems scope and objectives through research combined with an understanding of applicable business & EDI systems and industry requirements.

* Develops or modify information systems. Includes analysis of business and user needs, defining requirements and revising existing systems.

* Identifies a desired future state that addresses a business problem utilizing multiple analytic methodologies and business process modeling.

* Conducts research, impact analysis and determine to complete requirements elicitation and defining the breakdown of tasks, resource loading, issue tracking and resolution management.

* Collaborate with IT to identify and develop future state to ensure the accurate development of solution meets business requirements.

* Designs and develops approaches that are implemented by others.

* Perform analysis to support quality and continued process improvement recommendations to improve EDI acceptance rates and improve straight through processing to reduce file errors.

* Determines needs and capabilities of high profile, complex external customers to submit data electronically. Conducts data transfer testing, scheduling, and reviews and approves transaction in accordance to industry/ company/legal/security standards.

* Data transfer scheduling, monitoring and quality assurance activities Track daily data transfers and production schedules.

* Ensures quality assurance and HIPAA standards are rigorously followed to ensure EDI transactions are compliant with industry, company, legal and security standards.

* Performs analysis and develop process improvement recommendations to improve EDI acceptance rates and improve straight through processing and reduce file errors.

* Lead and/or perform User Acceptance Testing (UAT) and production business validation testing.

* Manage UAT defect identification, testing, resolution and validation process.

* Subject Matter Expert for routine to complex projects related to EDI processes and transactions.

* Prepares reports and statistics on electronic data transfer usage.

* Other duties as assigned.


ORGANIZATIONAL IMPACT:

* Works to achieve operational targets with direct impact on departmental results.

* Works independently under limited supervision.

* Work is reviewed for adequacy in meeting objectives.

* May be responsible for entire projects or processes within job area.


INNOVATION & COMPLEXITY:

* Responsible for improving processes, systems or products to enhance performance of the job area.

* Problems and issues faced are difficult, and may require understanding of broader set of issues.

* Problems typically involve consideration of multiple issues, job areas or specialties, and are typically solved through drawing from prior experience and analysis of issues.

* Develops new perspectives and approaches on existing problems.


COMMUNICATION & INFLUENCE:

* Communicates with parties within and outside of own department, with the ability to educate others on complex disciplines.

* May have responsibility for communicating with parties external to the organization (e.g., customers, vendors, etc.).

* Works to influence parties within and outside of the job function at an operational level regarding policies, practices and procedures.


LEADERSHIP & TALENT MANAGEMENT:

* May be responsible for providing guidance, coaching and training to other employees within job area.

* May manage projects requiring the responsibility of delegating work and reviewing resulting work product.

EDI ANLAYLST, SENIOR

ESSENTIAL RESPONSIBILITIES:

* Provides analysis, support and guidance to both internal and external customers on moderate to complex electronic data transfers covering enrollment, claims, billing statements and payments.

* Conducts routine data analysis, needs assessments, and cost/benefit analysis to align information technology solutions with business initiatives.

* Formulates and defines routine to complex systems scope and objectives through research combined with an understanding of applicable business & EDI systems and industry requirements.

* Develops or modify information systems. Includes analysis of business and user needs, defining requirements and revising existing systems.

* Identifies a desired future state that addresses a business problem utilizing multiple analytic methodologies and business process modeling.

* Conducts research, impact analysis and determine to complete requirements elicitation and defining the breakdown of tasks, resource loading, issue tracking and resolution management.

* Collaborate with IT to identify and develop future state to ensure the accurate development of solution meets business requirements.

* Designs and develops approaches that are implemented by others.

* Perform analysis to support quality and continued process improvement recommendations to improve EDI acceptance rates and improve straight through processing to reduce file errors.

* Determines needs and capabilities of high profile, complex external customers to submit data electronically. Conducts data transfer testing, scheduling, and reviews and approves transaction in accordance to industry/ company/legal/security standards.

* Data transfer scheduling, monitoring and quality assurance activities Track daily data transfers and production schedules.

* Ensures quality assurance and HIPAA standards are rigorously followed to ensure EDI transactions are compliant with industry, company, legal and security standards.

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.

Keywords: Blue Shield of CA, Sacramento , EDI Analyst, Senior, Professions , Lodi, California

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