EDI Technical Analyst (Claims) Job at Blue Cross Blue Shield of Arizona (Phoenix)

Job Description

Develops technical documentation, designs, analyzes, tests, provides end user support and training for new applications and data structures; and provides post-implementation review for systems and reporting to support customers and management. This position will be expected to assist with analysis required for all Trading Partner EDI and flat files.

Job Responsibility

Track and resolve basic or routine processing problems, coordinating with all areas
Research, analyze, track and resolve basic production problems
Develop business objectives, processing requirements, and technical specifications
Analyze files and map data from one system to another
Responsible for production cycles, solving production incidents and notification of problems
Write SQL queries needed for production support
Ability to query Splunk and App insight for logging results
Develop basic test data
Process test files and analyze test results
Create test files
Able to use standard API testing tools like SOAP UI or Postman
Perform execution of test cases/scripts
document results, log defects, and regression testing of defects
Perform test execution and defect reporting utilizing testing tools
Assist with root cause analysis and triage of key/critical defects for quick turn-around
Monitor and track traceability of business requirements to text execution
Participate in defect review meetings to explain and/or demonstrate defects
Develop and maintain SQL queries to test results and to create mock up data for testing and reporting
Assist with technical and data centered research required to produce and test Trading Partner files
Understand and apply TR3, Core CAQH and Blue Exchange rules
Learn business and systems data and process flows
and how they affects surrounding systems and operational areas
Research and analyze application procedural problems and provide recommendations for improvements and changes
Develop functional & technical specifications, logic flows and other documentation as applicable
Create Mapping Documents to move data between systems
Synthesize complex or diverse information, collect and research data, use intuition and experience to complement data, work flows and procedures
Review computer system capabilities, workflow and scheduling limitations to determine if requested application or application change is possible within the existing system
Translate business needs into technical solutions with knowledge of programming languages (SQL, C# or VB.net, ETL, SOA, and OLAP)
Participate in maintaining operational and disaster-recovery procedures
Write or modify procedures for internal use, operational procedures, and computer operations, as applicable
General understanding of cloud platforms, including AWS, Azure, kubernettes
Participate on small to large scoped projects
Use sound project management methodology and demonstrate solid time management skills
Create and deliver presentations
Monitor and create priority list(s) that are agreed to by user management
Research, analyze, track and resolve moderately complex production problems
Work with IT Infrastructure team to develop and implement effective production monitoring
Working knowledge of specific trading partner process flow
Working knowledge of various application integration for EDI
Research transactions to troubleshoot issues or analyze for data trends
Ensure the department leverages internal tools and applications effectively
Build, support, and maintain moderately complex processes, programs, and data
Participate or lead medium to large scoped projects
Create moderately complex ad-hoc reports for internal usage and external usage
Develop project plans, time estimates and project schedules based on prioritization and business requirements
Research and become proficient in one or more applications or data marts
Complete tech discovery with enough detail for development teams
Create Dashboards for monitoring transactions or performance on pieces of a transaction for the overall health of our process
Research, analyze, track and resolve high complex production problems
Build, support, and maintain moderately complex processes, programs, and data
Participate or lead Large scoped projects
Create complex ad-hoc reports for internal usage and external usage
Develop programs, time estimates and project schedules based on prioritization and business requirements
Facilitate and/or create new procedures and processes that support advancing technologies or capabilities
Research, analyze, track and resolve complex production problems
Build, support, and maintain complex processes, programs, and data
Evaluate high-level project information and assess project components to forecast work effort required
Provide peer-level review and mentoring to levels 1 – 3
Participate and/or lead complex technical projects
Create complex ad-hoc reports for internal usage and external usage
Act as a subject matter expert in two or more of areas as assigned: BI Production Reporting, Application Architecture, Application Architecture and Support, Training
Act as primary operational contact for internal and external customers when needed or in the absence of manager
Ensure Service Level Agreements between department and operational or technical areas are met
Lead, develop and mentor staff by providing opportunities for growth through delegation, training, and assignment to various project teams
Inform manager of any issues impacting the efficient and effective performance of the department including system, resource, and informational barriers
Provide timely feedback to team member on performance
Assist the manager in the day-to-day operations of the department
Understanding of EDI transactions
Each progressive level includes the ability to perform the essential functions of any lower levels and mentor employees in those levels
Maintain current on new developments in technology-related industries
Participate in corporate quality and data governance programs
The position has an onsite expectation of 1 day per week and requires a full-time work schedule
Participate in on-call rotation
Perform all other duties as assigned

Requirements

1 year of college-level coursework in system requirements design and interpretation and/or support of production systems (Level 1)
3 years of experience in computer technology and/or information systems (Level 2 – 4)
2 years of experience in data analysis, data management and integration, extracting and analysis reporting. (Level 2-4)
2 years of EDI experience (Level 1)
High-School Diploma or GED in general field of study (All Levels)
Intermediate skill in use of office equipment, including copiers, fax machines, scanner and telephones
Intermediate PC proficiency
Intermediate proficiency in spreadsheet, database, flow charting, and word processing software
Intermediate knowledge of data mapping techniques and data analysis software
Intermediate knowledge of computer operating systems
Intermediate knowledge of Microsoft Applications and Suites, Windows Server, and Microsoft SQL databases
Strong analytical skills to support independent and effective decisions
Ability to rapidly pick up new technologies
Ability to prioritize tasks and work with multiple priorities, sometimes under limited time constraints
Perseverance in the face of resistance or setbacks
Effective interpersonal skills and ability to maintain positive working relationship with others
Verbal and written communication skills and the ability to interact professionally with a diverse group, executives, managers, and subject matter experts
Systems research and analysis
Ability to write and present business intelligence documentation
Demonstrate the ability to stay current on global threats and vulnerabilities
Experience working with and managing third parties
Knowledge of business requirements development and user acceptance testing
Maintain confidentiality and privacy
Analytical knowledge necessary to generate reports based on available data and then make decisions based on reported data
Understanding of data governance best practices and data quality improvement principles

Nice to have

2 years of experience in computer technology and/or information systems (Level 1 -2)
2 years of experience working in healthcare-related systems as a business / systems analyst or programmer (All Lev)
2 years of experience with 27X, 834, 835 and 837
5 years of experience in data analysis, management, integration and reporting (Levels 3 – 4)
3 years of experience working in corporate enterprise-level systems as a business or systems analyst or programmer (Levels 3 - 4)
Bachelor’s Degree in Computer Science, Information Systems, Business, or related field (All Levels)
Knowledge of HIPAA regulations
Advanced proficiency in spreadsheet, SQL queries, database, flow charting, and word processing software
Advanced knowledge of data mapping techniques
Advanced knowledge of computer operating systems
Advanced knowledge of decision support systems
Advanced knowledge of programming, database systems, and data management
Advanced knowledge of the Edifecs EDI platform
Advanced systems research and analysis expertise
Impeccable project management skills
Solid technical ability and problem solving skills
Knowledge of internal departments and operations
Strong technical documentation skills and a strong ability to translate technical concepts so that they are easily understood by laypersons
Ability to provide mentoring and peer review to junior team members
Ability to build lesson plans and deliver lessons to junior team members

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EDI Technical Analyst (Claims)

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