Business Analyst III

 Emdeon Department of Veterans Affars Operations & Sales Team is responsible for all facets of VA EDI healthcare productivity:  Sales & Transactions Growth, New Product Implementation, Daily Customer and Field Supprt, Production Monitoring, Translator and Mapping Specifications, Issue/Error Resolution and Communication with Payers, Customers, Internal and External Management & Technical Support Staffs. is position, the successful candidate will be responsible for creation and enhancements of translator & format maps, production monitoring and in-depth analytical research and problem-solving to ensure successful business processing and growth of a key national account.

 

Job responsibilities include:

 

Data mapping (inbound and outbound) of healthcare claim information from X12 transactions sets to internal proprietary formats and paper claim forms.  Provide system specifications for new transaction sets/maps, modifications and enhancements; compile test cases, analyze results and QA through production implementation.

 

Proactive monitoring of X12 production & systems processing to identify, report and resolve issues with customer data, internal and external translators, and system processes.

 

Detailed analysis and in-depth research of payer requirements, HIPAA guides, payer companion guides, industry practices, translator and technical specifications to identify errors and formulate solutions, new procedures and/or specifications.

 

High Level Customer/Development Support.  Daily communication with customer, payers, internal and external technical staff via email, conference calls and meeting attendance.  Experience with VA rules and regulations will be helpful.  Local candidates only. The detialed requirements are essential and you will not be considered if you do not posess all listed skills. 

 

 

Skills required:

In-depth knowledge of HIPAA X12 transaction sets (837 health care claim and 835 remittance advice required) 270/271, 276/277 and 278 real-time transactions sets a plus

 

Demonstrated ability to map data from X12 transactions sets to internal proprietary formats and paper claim forms coordinating all lines of business and payer specific exception processing. 

 

Proven Industry knowledge of health care claim processing.  Candidate must have superior understanding of institutional and professional claim requirements, payer specifications and provider id usage.  Experience with secondary claims, COB & 835 processing preferred. 

 

AA or BA in Business, CIS or health related field with prior experience in data processing (Mainframe and JCL experience preferred, UNIX a plus).  Equivalent industry experience may be substituted for degree.  Prior Business Analyst, Claims & Customer Support experience preferred.  Microsoft Office Competency required; Access skills a plus.

 

Position will be based in Emdeon Headquarters - Nashville, Tennesse

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