Medicare Advantage EDI Analyst

Take 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 HIPPA/CMS standard sets. You will focus on delivering operational efficiencies and meeting claim data submission requirements.

* 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-resolutions 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