1+ months

EDI Analyst (Eligibility & Recovery)

Sunrise, FL 33351
Regular Full Time
Pay Range: 72400-94000


The EDI Analyst will be responsible for evaluation of all healthcare related EDI X12 files along with research and comprehension of the underlying data used to generate the files. The EDI Analyst will work with the Eligibility & Recovery business to ensure accurate claim delivery and leverage experience in healthcare claims, eligibility, Coordination of Benefits (COB) or Third-Party Liability (TPL), to maximize claim acceptance rates.

Essential Duties:
Leverage knowledge and expertise in COB/TPL/MSP to review EDI X12 files, along with the corresponding eligibility and client data.
Review and analyze EDI X12 files, eligibility and/or client data to identify trends, patterns, and potential improvements. 
Assist with technical and functional requirements gathering, documentation, and project management for new EDI implementations.
Responsible for EDI Mapping, Transaction Validation, and testing.
Develops custom queries and reporting to identify trends and patterns within EDI response files, including but not limited to 277s and 835s.

Conducts research, analyzes trends and activities, and presents data and findings based upon business needs and as need to identify opportunities, root causes of issues and to support business decisions and strategies.
Follows and complies with company, departmental and client program policies, processes, and procedures.
Responsible for utilizing resources to ensure compliance with client requirements, HIPAA, as well as applicable federal or state regulations.
Successfully completes, retains, applies, and adheres to content in required training as assigned.
Completes required processes to obtain client required clearances as well as company regular background and/or drug screening; and successfully passes and/or obtains and maintains. clearances statuses as a condition of employment. (Note: client/government clearance requirements are not determined or decisioned by Performant.)
Demonstrates Performant core values in performance of job duties and all interactions.
Correct areas of deficiency and oversight received from quality reviews and/or management.
Performs other duties as assigned.

Required Skills and Knowledge:

Required Skills

Advanced knowledge of EDI Transactions, including, but not limited to 270/271, 834, 277, 837, 835 

Knowledge of and ability to work with large volumes of health care eligibility and claims data
Experience with Medicaid / Medicare / Other TPL business models and products
Knowledge of requirements gathering and ETL processing
Strong system skills with ability to quickly develop expertise in new systems and applications
Advanced skills in Excel, Access and/or other data analysis applications
Proficient SQL skills to query and test 

General understanding and ability to read Python
Professional verbal and written communication with good presentation skills
Able to work independently and meet deadlines with minimal supervision
Strong problem solving and communication (written and oral) skills
Ability to produce results and maintain positive attitude in fast paced, dynamic environment
Self-motivated and thrives in a fast-paced business operations department performing multiple tasks   cohesively, with keen attention to detail

Physical Requirements:
**NOTE: Must be able to meet requirements for and perform work assignments in accordance with Company policies and expectations on a home remote basis (and must meet Performant remote-worker requirements) until at which time staff will be notified and required to work from a Performant office location. Basic office equipment required to perform remote work is provided by the company.
Job is performed in an standard busy office environment with moderate noise level (or may be home-office setting subject to Company approval and Teleworker Agreement), sits at a desk during scheduled shift, uses office phone or headset provided by the Company for calls, making outbound calls and answering inbound return calls using an office phone system; views a computer monitor, types on a keyboard and uses a mouse.
Reads and comprehends information in electronic (computer) or paper form (written/printed). 
Sit/stand 8 or more hours per day; has the option to stand as needed while on calls; reach as needed to use office equipment.
Consistently viewing a computer screen and types frequently, but not constantly, using a keyboard to update accounts.
Consistently communicates on the phone as required primarily within the department and company and may include client contacts or other third-party depending on assignment with account holders, may dial manually when need or use dialer system; headset is also provided.
Occasionally lift/carry/push/pull up to 10lbs.

Other Requirements:

Must submit to and pass pre-hire background check, as well as additional checks throughout employment
Must be able to pass a criminal background check; must not have any felony convictions or specific misdemeanors, nor on state/federal debarment or exclusion lists.
Must submit to and pass drug screen pre-employment (and throughout employment).
Performant is a government contractor. Certain client assignments for this position requires submission to and successful outcome of additional background and/or clearances throughout employment with the Company.
Visa sponsorship is not available.

Job Profile is subject to change at any time.

Performant Financial Corporation is an Equal Opportunity Employer. 
Performant Financial Corporation is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, age, religion, gender, gender identity, sexual orientation, pregnancy, age, physical or mental disability, genetic characteristics, medical condition, marital status, citizenship status, military service status, political belief status, or any other consideration made unlawful by law. 



Education and Experience:
Bachelors degree in relevant field or equivalent combination of education and experience.
5+ years relevant experience working with healthcare EDI X12 formatted files and data.
Knowledge and experience with Healthcare, Coordination of Benefits, Third Party Liability, and/or Medicare Secondary Payer.

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Posted: 2023-09-18 Expires: 2023-12-03
Analytics, audit, and recovery services for healthcare, government and student loans.



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EDI Analyst (Eligibility & Recovery)

Performant Financial
Sunrise, FL 33351


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