EDI Associate

The EDI Transactions Team is responsible for the processing, monitoring and exception handling for electronic transactions at athenahealth. This includes electronic claim submission, eligibility checking, electronic remittance advice, reporting and other communication to insurance carriers and industry clearinghouses. The team is additionally responsible for the implementation of format changes affecting electronic claim submission, eligibility checking and remittance advice, such as changes to various HIPAA transaction standards or updates to current connections as partners adopt mandated standards.

The ERA (Electronic Remittance Advice) Associate is responsible for supporting the implementation of ERA transaction processing applications and department ERA activities including: ERA testing for new payors; infrastructure and process development; transaction flow analysis and monitoring; and projects and initiatives as assigned. The ERA Associate will report to the EDI Transactions Manager based at our headquarters, located in Watertown, Massachusetts.

Responsibilities may include, but are not limited to:

1) Analysis

Determine beta client pool and coordinate ERA enrollment in support of new payor testing

Analyze results of Claredi reports to determine quality of 835 data received from payor

Analyze results of new payor testing and communicate problem identification and resolution to development resources and coordinate corrective action

Research and implement athena kickcode mappings in support of new payor testing and implementation in production environment

Analyze trends and resolve root-cause issues by working with vendors, payors and various athena departments that are stakeholders in electronic transaction processes (e.g. Enrollment Services, Payor Performance Management, Client Services, Rules Team)

Provide lead coordination for reporting metrics for ERA operations

Report on daily, weekly and monthly transaction processing activity to EDI Transactions Manager and ERA team

2) Technical

Research complex transaction submission/rejection problems

Write/execute SQL queries in support of new payor testing and troubleshoot operational issues

Provide lead coordination on test environment and linkage set-up, beta and production releases, in support of new payor implementations, working with various athena departments

Document test cases and coordinate new payor testing with members of posting team

Document policies and procedures for transaction submission/rejection problem-solving based on solid analytical evidence

Track ERA connectivity implementation and operational statuses

Demonstrate ability in building customized internal reporting using available tools


3) Transaction Support

Support the initial setup and testing of ERA transactions as necessary

Conduct routine audits to determine overall quality performance of ERA transaction operations

Maintain lead on special projects relating to updating the transition of legacy accounts, connectivity, and reporting from clearinghouses and vendors

Work effectively with Customer Support to troubleshoot and resolve ERA transaction issues with customers

Use baseline research and analysis to advocate for product and process improvement

Train EDI Analysts in their daily ERA responsibilities and ?best practice? problem solving based on trends and analysis

Required of all athenahealth employees:

The ERA Associate must adhere to the business and cultural goals required by all employees of athenahealt

Performance

Dedication to the corporate mission to become the most trusted and effective business service to health care providers in the world;

Commitment to athenahealth?s social mission to improve the quality of healthcare for all;

Commitment to athenahealth?s Corporate Compliance Code, including escalation of all compliance issues through the chain of command andto the company?s Compliance Officer and/or General Counsel;

Unconditional support of athenahealth?s cultural mission to be a community of teachers, learners and winners, including:

Belief in the primacy of the group over the individual ? that ?super-performers? are those who most help the performance of those around them rather than those who produce the most themselves;

Creating a virtuous circle of learning and innovation through fostering his/her innate curiosity and desire to: 1) master his/her job, 2) innovate in his/her area of responsibility, whatever its scope and 3) teach other athenistas about what s/he has learned;

Demonstrate unconditional positive regard for the personal worth (distinct from a particular individual?s actions) of all other athenistas, and act accordingly;

Fueled by the passionate desire to make his/her role and athenahealth a terrific success, every athenahealth employee will do what it takes to get the job done, including sometimes working unpredictable, long hours to perform a diverse array of tasks.

Skills

High level understanding of the three major services lines and of the organization?s responsibility for delivering on them;

Understanding of the Balanced Scorecard and each department?s responsibilities under it;

Excellent communication skills (particularly listening and speaking);

Maniacal attention to detail;

Willing/excited to work in a fast-paced, but sometimes intense, rapidly expanding company;

Strong computer literacy and/or the comfort, ability and desire to advance technically.

Required of All Employees of Claims and Remittance Services[Department-specific requirements]:

Professional attitude ? comfortable working in a corporate setting populated by diverse types of people and able to maintain poise and a sense of humor in stressful situations

Attention to detail

Personal motivation and drive

Understanding of the needs of our clients and how the attainment of our goals will meet those needs

Focus on Quality of Service to our clients as our driving principle

Understanding of the business need to attain ever more challenging goals

Understanding of the need for continuous improvement of our processes and ourselves to support athenahealth?s mission

Flexibility to participate in pilot programs and other change-oriented endeavors that will expand our capabilities

Willing to be the one to reach out and provide at least 51% of the commitment and effort required to solve a problem in concert with other athenahealth employees

Willing to vary job responsibilities to meet the needs of the team as it adjusts to meet the needs of our clients

Desire to learn as much as possible about our core systems.


Bachelor?s degree or equivalent combination of education and experience required; Master?s Degree desirable

Extensive experience working with the electronic transactions mentioned above is highly desired

Demonstrated capability to perform technical & analytic work as an individual contributor; as well as succeed in demonstrating informal leadership and supervisory abilities

Understanding of, and facility with, the HIPAA mandated X12N standard; acknowledgement; and unsolicited reporting formats is highly desired


Experience creating SQL queries and analyzing results is desired

Ability to research complex ERA and transmission problems from identification through to resolution

Demonstrated project management skills encompassing constraint management, customer relationship and expectation management, and cross-functional/matrix management

An understanding of communication and IT architectures, security, and troubleshooting

The ability to contribute professionally to the strategic goals of the department by formulating and justifying ERA programs, transition operations, and development needs

Must be self-directed and able to develop own high priority projects, with a proven ability to meet aggressive deadlines

Must be able to develop relationships and work effectively in a cross-functional environment

Understanding of the process of medical billing and/or EDI claim processing is highly desired

Superior communication skills are required