Job Description :
Direct End Client: State of Maryland
Job Title: Senior EDI Analyst
Duration: 12 Months
Start Date: 07/05/2017
Location: 901 Elkridge Landing Road, Linthicum, MD 21090
Position Type: Contract
Interview Type: Phone/ Skype OR In-Person
Requirement ID: SMD_EDI717_BR
Description:
State of Maryland – Maryland Health Benefit Exchange (MHBE)
The Maryland Health Benefit Exchange (MHBE) created a website and call center operating under the name Maryland Health Connection (MHC Through MHC, Maryland residents explore health insurance plans, compare rates, and determine their eligibility for advanced premium tax credits (APTC), cost sharing reductions (CSR) and public assistance programs such as Medicaid and the Maryland Children’s Health Insurance Program (MCHP
MHBE is seeking Senior EDI Analyst to support the MHBE IT Electronic Data Interchange (EDI) Operations. The Senior EDI Analyst will be responsible for understanding, defining, analyzing, coding, evaluating, testing, debugging, documenting, and implementing complex EDI processes and applications for the development and maintenance of the Maryland Health Benefit Exchange (HBX) and related systems.
Responsibilities:
Perform 8001 Flat File validation and analysis; review multiple MPIs for SSN matching.
Perform HBX System Error analysis.
Validate 1095-A and 1095-B files, reconcile 8001 transactions.
Work for the EDI Operations team to provide EDI related services for the Exchange.
Analyze EDI files sent to and received from Carriers/Managed Care Organizations (MCO) and identify errors and root cause for EDI file rejections.
Coordinate with the development team, business operations team and the testing team to analyze, fix, test and transmit EDI files on a daily basis.
Analyze the EDI 999 files from the Carriers and MCOs and perform root cause analysis for exceptions.
Perform data changes to fix consumer or system reported errors, coordinate with technical and business teams to analyze error reports, access HBX database and application to perform root cause analysis for transaction rejections.
Communicate with MHBE IT team, business team, vendor team and other stakeholders to translate business needs into EDI data fixes and solutions.
The candidate must have the flexibility to work overtime as needed, including weekends, holidays, and off-hours.
Minimum Qualifications:
A minimum of four (4) years of experience with Health Exchange EDI solutions.
A minimum of four (4) years of experience in creating EDI X12 files for transactions sets such as 834, 999 and TA1.
A minimum of four (4) years of experience in reviewing and understanding technical documents such as companion and implementation guides for Healthcare EDI formats 834 and 999.
A minimum of four (4) years of experience in analyzing/ testing Healthcare/ Marketplace EDI Applications.
A minimum of two (2) years of experience working with SQL databases/ queries.
Strong analytical and problem solving skills.
Excellent communication skills including the ability to understand and communicate technical information to business users, and gather business requirements that can be translated into technical requirements.
Ability to manage multiple critical priorities and tight deadlines.
Preferred Qualifications:
Six (6) years of experience with EDI validation tools such as Edifecs, WTX, EDI X12 files.
Six (6) years of experience with transactions sets such as 834, 999 and TA1, SOA, EDI and EAI Applications.
Knowledge of 8001/ IDB file processing.
Knowledge of Medicaid coverage types, coverage span and eligibility rules.
Strong knowledge in the Affordable Care Act (ACA) eligibility rules.
In-depth understanding of 834 enrollment transactions including Adds, Terminations, Cancellations and Life events.
Strong knowledge of DB2 database and SQL scripts.
Experience in quality assurance and quality control of a large scale Healthcare System.
Place of Performance:
The candidate must have the ability to report to various locations as needs and meetings require.
1. Primary work location will be: 901 Elkridge Landing Road, Linthicum, MD
2. Secondary work location will be: 750 East Pratt Street, Baltimore, MD
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