Senior EDI Solutions Analyst

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

 

Have you been working with Utilization Management systems and/or Claims Payment systems and their associated HIPAA X12 EDI 278 Authorization transactions? Are you looking for an opportunity to expand your experience working with EDI 278 integrations in the health care industry? We have a great opportunity for an individual to lead trading partner integrations from end to end working with our proprietary Medical Management system (MMS) and connecting it to a variety of Claims systems (FACETS, IDX, Xcelys and IKA, just to name a few).

 

The Sr. EDI Solutions Analyst ensures that the technical integration between the MMS and Claims systems is seamless to our end users for all Authorization Data using an EDI 278 transaction. Our technical environment includes an Azure cloud-based database solution where we talk to a PostGres SQL databases for our core application database technology along with leveraging Snowflake SQL to interact with our reporting data warehouse for conducting EDI 278 statistical analysis on the health of our EDI 278 integrations as well as conducting deep dive transaction research for troubleshooting integration issues. You will use your existing database SQL skills to broaden your understanding of the required data mapping necessary to stand up the EDI 278 transaction for our trading partners.  Can you articulate and interpret business requirements and compare them against the industry standard technical implementation guide of the X12 278 transaction giving trading partners real-world scenario variances of the allowed usage for the specific loop-segment-element of the EDI 278 transaction?  If this sounds like what you have been doing and something you want to continue to build upon your existing in-depth knowledge of how the EDI 278 (Authorization/Referral) transaction works in health care, please read on and apply as we have an opening on our team and would like to hear from you about your existing specialized experience in this space.  

 

Primary Responsibilities:

• Monitor Daily EDI Transaction Processing
• Troubleshoot and resolve any EDI processing issues
• Implementation Team Resource for EDI Mapping, Validation and Testing as required
• Prepare and update program documentation, job aides, and other artifacts as requested
• Scheduled and ad hoc auditing of various systems and databases to support prior authorization transactions
• Process review, data analysis and measurement for various programs related to prior authorizations, claims and member eligibility
• Create process and data flow diagrams for the various programs/projects as assigned
• Preparation of reports as needed by management
• Identification and communication of processing issues to leadership
• Prepares and coordinates presentations, training, etc; used as an educational resource
• Implementation of new technologies and processes (includes testing and follow up)
• May involve some interfacing with clients, managed care customers, IT resources and others when needed
• Assignment of special projects as needed

 

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
 

Required Qualifications:

• 5+ years of Experience in each of the following:
• Experience within the healthcare data environment – eligibility, provider, claims, etc
• Experience with data mapping and workflow documentation
• EDI transaction mapping experience
• EDI Production Support and Maintenance Experience including editing and correcting EDI 278N X12 package data for resubmission
• EDI testing and validation experience
• Healthcare IT MMS (Medical Management Systems) experience
• Experience with SQL (manipulating data and queries) – Relational databases like MySQL, MS SQL, DB2
• Experience using Microsoft Word (creating and editing documents), Microsoft Outlook (email and calendar), Microsoft Excel (pivot tables, formulas (vlookup, xlookup, match, etc..) and Microsoft Visio (process/data flow diagrams)
• Experience using Microsoft Viso (creating and editing documents) to illustrate process or data flow diagrams
• Proven healthcare EDI Transaction Knowledge and Expertise
• Proven specific EDI X12 ANSI 278 Transaction Expertise
• Proven solid organization skills and attention to detail
• Proven excellent communication skills, both verbal and written, with the ability to interact with various levels of resources internally and externally

 

Preferred Qualifications:

• Experience building both EDI 278 real-time and batch mode integration services
• Experience with ETL (Extract Transfer Load) File Management and Archive Processes
• Experience working with cloud-based solutions and services
• Knowledgeable about claims billing practices and process management concepts – this may include knowledge of CPT coding or reimbursement processes, 3rd party provider enrollments, claims submissions, EDI and HIPAA transactions and/or accounts receivables
• Proven ability to write clear technical and functional specs for authorization data integration services

 

Telecommuting Requirements:

• Dedicated work area established that is separated from other living areas and provides information privacy
• Ability to keep all company sensitive documents secure (if applicable)
• Live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

 

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives. The salary for this role will range from $89,900 to $160,600 annually based on full-time employment. We comply with all minimum wage laws as applicable.

 

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes – an enterprise priority reflected in our mission.

 

 

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug – free workplace. Candidates are required to pass a drug test before beginning employment.