EDI Data Analyst

Dynamic Healthcare Systems, a wholly owned subsidiary of Reveleer, is looking for an individual with Medicare EDI experience to join our team. The EDI Data Analyst will support new and current EDI risk adjustment customers. The Data Analyst will work directly with clients to assure timely, accurate, consistent, and complete submissions of encounter data. Additionally, you will assist clients in mapping encounter data files to Dynamic standard formats, track inbound/outbound files sent by clients and processed in our proprietary software (Voyager), review errors received and document the errors with business friendly explanations, and assure optimal data integrity. You will identify data issues or discrepancies between CMS rules and Voyager rules and report to the appropriate parties. In this role, you will thoroughly analyze issues, identify the root cause, and work with the Integration team and Software Development team to correct the problems. Every person at Dynamic has a hand in exceeding our clients’ expectations, and you will play a key role in assuring our clients are fully utilizing the EDI risk adjustment module, and enjoying the full value of the solution. Your daily work is likely to consist of:

  • Performing audits on data imported and data exported
  • Performing reconciliation on submitted records vs. received responses
  • Providing analysis for root cause and correction actions for risk adjustment customers’ Voyager errors
  • Tracking and following up on risk adjustment files received, processed and submitted
  • Documenting all mapping changes or issues
  • Documenting weekly statuses, meeting minutes and clients’ concerns
  • Keeping up to date on CMS changes and assisting with development of new business requirements and functional specifications as they relate to risk adjustment

The Ideal Candidate will bring:

  • Medicare Advantage experience at the plan level in a systems operations capacity, interfacing with both the plan and CMS
  • Three or more years of experience in Medicare risk adjustment and ANSI X12, working with Palmetto, CSSC, and CMS
  • Experience processing 5010 and 837 files
  • Advanced Data analysis in SQL
  • Interfacing with clients to gather requirements and review operational statuses
  • Excellent application troubleshooting based on data analysis
  • Strong communication skills, both verbal and written
  • Bachelor’s degree or equivalent experience is required