EDI Analyst

Affinity Health Plan, an independent, growing, not-for-profit managed care company designed specifically to serve the needs of low-income New Yorkers, needs an EDI Analyst. You will provide analytical support and process improvement leadership for Affinity’s Electronic Data Interchange (EDI) initiatives. Evaluate, develop, maintain and improve policies and practices for EDI transactions. As part of your responsibilities, you will:

 

1.  Analyze and evaluate operational workflows, re-engineering opportunities and system enhancements to implement new and improve existing EDI transactions that support business requirements.  Improve operating results through the development, implementation and maintenance of EDI transactions that support standardized and integrated business practices. 

2.  Analyze daily and monthly EDI claims receipts and data to identify and resolve existing or potential issues that would impact efficient and accurate claims adjudication and/or claims status.

3.  Develop and implement process improvements for claims processing through on-going analytical, technical and operational support for 837, 835, 277U, 276/277, and 270/271 transactions.. Evaluate and analyze the processes associated with claims submission and review to ensure that all processes, policies and procedures are supported by EDI processes.  Works with management and staff at Affinity who support claims processing and with providers to ensure rhat EDI solutions support internal and external customer needs.

4.  Develop and manage project plans for EDI transaction initiatives and support the implementation of new or revised practices and procedures.

5.  Ensure that all EDI services are fully compliant with HIPAA and all other regulatory requirements.

6.  Provide on-going technical and consulting support to users of EDI transactions internally and externally.

7.  Develop and conduct programs to train staff on new and/or revised EDI services.

8.  Prepare and maintain up-to-date documentation of all operating policies and practices associated with EDI transactions, adhering to corporate documentation standards.

9.  Perform other duties as requested or assigned.

 

 

Qualifications

 

· Bachelor’s degree in management, health care administration or related field required or equivalent knowledge.

· Minimum one (1) year of work experience in development, analysis and/or implementation of EDI transactions in a health care, or similar setting.  Experience with healthcare related EDI transactions is required.

· Working knowledge of HIPAA regulations and requirements.

· Advanced level proficiency with Microsoft Office (Word, Excel, Outlook, Power Point and Access.)

· Excellent verbal and written communication skills.

· Demonstrated ability to analyze complex issues, integrate complex functions and identify solutions to resolve specific business issues.

· Special interpersonal skills and demonstrated ability to work effectively with all levels of an organization to identify opportunities, and develop and implement solutions.

· Ability to work and think independently, and to exercise independent judgment guided by policies, goals and objectives.

· Highly developed organizational, problem solving and prioritization skills.

· High level of integrity.

 

If you meet these qualifications and are interested in this position, please respond through our website, www.affinityplan.org under Careers/Open Positions on the main page.  You can also fax your resume to 718-794-7846, stating that you are applying for this position on the fax cover sheet or cover letter. Only qualified applicants will receive a response.