Job Description
The EDI Analyst position generates EDI 837P/I/D encounter files (containing adjudicated claims data) in the format specified by our Health Plan partners, DHCS, or designated third parties. The EDI Analyst is also responsible for the delivery of files and management of the response files received to ensure that encounter files are processed in compliance with Health Plan guidelines and state and federal standards. The EDI Analyst may be asked to participate in Health Plan meetings as an Encounter SME.
Minimum Requirements
Bachelor’s degree or equivalent experience required.
Minimum of 4 years of managed health care experience is required; preferably working for a Health Plan or Managed Services Organization.
Minimum of 2 years working with ASC X12 837 files, specifically 837P, 837I, 837D, 277CA, 999, TA1.
Minimum of 2 years generating and submitting healthcare EDI files and a working knowledge of SQL databases and queries.
Prior knowledge of ICD-10, CPT, HCPCS, NDC coding, and experience working with an EDI Clearinghouse(s).
Familiarity with healthcare lines of business - Medicare, Medicaid, and Commercial - is a plus.
At Altura, we provide management services to health care providers. Our mission is to alleviate the administrative burdens of operating a medical practice, thereby allowing our clinician partners to focus on patient care. We elevate quality outcomes for patients, by incorporating value-based care objectives throughout our health care networks -- while also enabling financial success of our clients. We are committed to innovation and investment in the latest technologies. We focus on building solutions that address the needs of our providers and their patients.
At Altura, we provide management services to health care providers. Our mission is to alleviate the administrative burdens of operating a medical practice, thereby allowing our clinician partners to focus on patient care. We elevate quality outcomes for patients, by incorporating value-based care objectives throughout our health care networks -- while also enabling financial success of our clients. We are committed to innovation and investment in the latest technologies. We focus on building solutions that address the needs of our providers and their patients.
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