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Location

Alhambra, CA | United States

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Job description

Job Title: EDI Analyst

Department: Data

About the Role:

We are seeking a highly skilled and detail-oriented EDI Analyst to join our healthcare organization. As an EDI Analyst, you will play a crucial role in ensuring the smooth exchange of electronic data between our healthcare systems and external partners, including insurance companies, providers, and other stakeholders. You will be responsible for analyzing, troubleshooting, and optimizing electronic data interchange (EDI) processes to enhance operational efficiency and data accuracy within our healthcare network.

What You'll Do:

• Provide analysis, support and guidance to both internal and external clients on electronic data transfers pertaining to inbound claims processing and outbound encounter submissions
• Conduct data analysis, needs assessment, and cost/benefit determination to align EDI strategies with the goals of the organization
• Collaborate with business partners to identify and translate business requirements into functional systems requirements
• Identify a desired future state that addresses business problems utilizing data analysis and process modeling
• Write P&Ps, manuals, and other technical EDI documentation
• Perform analysis to promote high quality and continued process improvement of EDI acceptance rates improving volume, timeliness, and to gain overall efficiencies in claims and encounter processes
• Lead and/or perform user acceptance testing and production business validation testing for assigned projects
• Attend IPA and health plan meetings pertaining to claims and encounter data as required
• Perform ad hoc duties, projects, and actions as needed

Qualifications:

• Bachelor’s degree or equivalent and relevant information technology training from an accredited institution
• A minimum of two years of health plan, IPA, or MSO experience
• Advanced knowledge of data interpretation and data analysis tools
• Knowledge of health plan operations around membership, claims, and encounter data processing
• Familiarity with HIPAA transaction standards and encounter data landscape, specifically 834, 835, 837P, 837I, 837D, 277,999, and TA1
• Proficient with Microsoft Office (Word, Excel, PowerPoint) and SQL
• Proven ability to prioritize and organize multi-faceted/multiple responsibilities simultaneously in a fast paced, changing environment while meeting deadlines and turnaround time requirements
• Must be able to work independently utilizing all resources available while staying within the boundaries of duties
• Excellent communication and documentation skills with the ability to creatively solve problems

Who We Are:

ApolloMed (NASDAQ: AMEH) is a physician-centric, technology-powered healthcare management company. We are building and operating a novel, integrated, value-based healthcare delivery platform to empower our physicians to provide the highest quality of end-to-end care for their patients in a cost-effective manner. Our mission is to combine our clinical experience, best-in-class delivery network, and technological expertise to improve patient outcomes, increase access to healthcare, and make the US healthcare system more efficient.

Our platform currently empowers over 10,000 physicians to provide care for over 1.9 million patients nationwide. Our rapid growth and unique position at the intersection of all major healthcare stakeholders (payer, provider, and patient) gives us an unparalleled opportunity to combine clinical and technological expertise to improve patient outcomes, increase access to quality healthcare, and reduce the waste in the US healthcare system.

Our Values:

• Put Patients First
• Empower Entrepreneurial Provider and Care Teams
• Operate with Integrity & Excellence

• Be Innovative
• Work As One Team

Environmental Job Requirements and Working Conditions:

• This position is remotely based in the U.S.
• The compensation target pay range for this role is: $75,000 - $85,000. The salary range represents our national target range for this role.

ApolloMed is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at [email protected] to request an accommodation.

Additional Information:

The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.

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Job tags

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Salary