Medicare Advantage EDI Analyst

Company: Academy of Managed Care Pharmacy
Location: Los Angeles
Posted on: October 19, 2024

Job Description:

DescriptionTake on a significant role within a world-class health organization. Elevate the operational effectiveness of a complex health system. Take your professional expertise to the next level. You can do all this and more at UCLA Health.As an important member of our Medicare Advantage Operations team, you will be instrumental in maintaining and running processes/jobs for electronic claims and other EDI transactions. This will involve working with external trading partners, transferring/loading data through secure channels, and testing files from new providers/trading partners. You will be responsible for claim encounter data submissions and the coordination of business transactions for all HIPAA/CMS standard sets. You will focus on delivering operational efficiencies and meeting claim data submission requirements.Salary Range: $76,200 - $158,800/annuallyQualificationsWe're seeking a self-motivated, detail-oriented, customer-focused leader with:

• Bachelor's degree in computer science, information technology, business, or a related field, and five years of experience, or an equivalent combination of education and experience required.
• Five or more years of experience with CMS processes in a Medicare or managed care environment.
• Must have 3-5 years of experience with Encounter submission (837 I, P, 999 and 277) to/from CMS is required.
• Advanced proficiency with SQL, SSIS package, data visualization tools, and Microsoft Office.
• Knowledge of physician and facility billing practices, appropriate CPT coding initiatives, ICD-10 coding standards, and revenue/HCPCS coding.
• Extensive experience with claims encounter strategies and processes.
• Knowledge of claims payment methodologies, adjudication processing, and Federal encounter regulations.
• Knowledge of encounter regulatory reporting and compliance requirements.
• Previous vendor management experience.
• Ability to research and resolve encounter issues.
• Understanding of the health care model, capitation, and other managed care IPA and provider reimbursement methodologies.
• Excellent communication, interpersonal, analytical, and problem-resolution skills.
• Ability to modify and adapt operational procedures to changing operational needs.
• Strong leadership, critical thinking, and prioritizing abilities.
• Ability to develop, implement, and evaluate methods and systems to improve efficiency.
• Ability to articulate ideas to both technical and non-technical staff.UCLA Health is a world-renowned health system with four award-winning hospitals and more than 260 community clinics throughout Southern California. We are also home to the David Geffen School of Medicine, a highly respected leader in the development of breakthrough medical research and outstanding clinical professionals. If you're looking to experience greater challenge and fulfillment in your career, you can at UCLA Health.
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Keywords: Academy of Managed Care Pharmacy, Rosemead , Medicare Advantage EDI Analyst, Professions , Los Angeles, California