Analyst, EDI, MVP Health Care (Job ID: 1139)

Posted: 01/16/18 | SHARE:

Description:

MVP Health Care is a nationally-recognized, regional not-for-profit health plan.  We are committed to having a positive impact on the health and wellness of everyone and every community we serve. We care for more than 700,000 members across New York and Vermont, and we are powered by the ideas and energy of more than 1,600 employees – providing a wide range of health benefit plan options with attentive service and flexibility normally associated with a smaller company.  Stop settling for “just a job,” and join a company where you can reach your full potential…and make a positive difference!

JOB SUMMARY:

The EDI Analyst will ensure compliance with all of MVP’s EDI transactions and identify root cause issues in relation to files failing compliance. Will work cooperatively with IT and EDI Coordinators to improve overall EDI compliance. Ensures established EDI transaction (837I, 837P, 835, 270, 271, 276, 277) protocols are adhered to and that transactions remain in compliance with HIPAA and CAQH requirements. Troubleshoots and establishes innovative processes to guarantee EDI transactions routinely pass compliance. Analyzes monitors and tests claims related to EDI compliance failures. Proactively identifies areas for efficiencies and improvement within department; consistently challenges the status quo in favor of incremental improvement opportunities that could be achieved through new methods. Works with Operations Compliance team to ensure proper ANSI code mapping for Facets explanation codes. Works with MVP’s transaction vendors to ensure compliance, testing enhancements and root cause of issues. Ability to act in a consultative manner with MVP staff at all levels of the organization. Ability to maintain confidentiality and adhere to regulatory compliance issues as they exist and change from time to time. Performs other related duties as assigned. 

 

 

Qualifications:

Minimum Experience:
Two years EDI experience preferred. Claims experience preferred.

 

Required Skills:
• Strong analytical Skills

• Superior Problem Solving and Judgement

• Process Improvement

• Cross-Departmental Collaboration

• Facets Knowledge preferred 

 

Additional Information:

MVP Health Care is an Affirmative Action/Equal Opportunity Employer). We recruit, employ, train, compensate, and promote without regard to race, religion, creed, color, national origin, age, gender, sexual orientation, marital status, disability, genetic information, veteran status, or any other basis, e.g., Pay Transparency, protected by applicable federal, state or local law. Any person with a disability needing special accommodations to the application process, please contact Human Resources at hr@mvphealthcare.com.

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