System Operations Analyst

The System Operations Analyst (SOA) is responsible for overseeing the day-to-day Electronic Data Interchange (EDI) operations, ensuring the smooth flow of electronic transactions between our organization and external partners. The System Operations Analyst will play a vital role in monitoring, troubleshooting, and optimizing EDI processes to enhance operational efficiency. Ultimately, their goal is to aid in fulfilling our mission of positively impacting the health and wellness of those we serve in our community., * Processes all inbound and outbound feeds necessary to achieve positive outcomes including eligibility, claims, maximum out of pockets, health plan employer data and information sets, and any other electronic data interchange files as required

• Prepares source data for computer entry by compiling and sorting information, establishing entry priorities to enter data into the EPIC Tapestry system
• After manually or automatically uploading information, determines if any data integrity issues were found and creates/executes reports to the team leader/manager for resolution
• Assists in loading EPIC files such as Claims, Encounters, MOOP, Eligibility, 835, 837 and other files
• Performs tasks to effectively test loads as Claim, Eligibility and MOOP loads, AP Claim payment process
• Processes workflow/standard operating procedure documents by reviewing data for deficiencies, resolving discrepancies by using standard procedures or returning incomplete documents to the team leader/manager for resolution
• Ensures data loads are completed timely and accurately in EPIC Tapestry system to ensure timely claims payment
• Performs validation when necessary of critical business data details for providers found in various industry specific websites, databases, and internal documents
• Maintains data entry requirements by following pre-defined data program techniques and procedures
• Monitors CRM requests to accurately update data in the system in accordance with established guidelines
• Follows workflows and adheres to established Policy and Procedures to comply with all daily responsibilities
• Consistently meets assigned project deadlines and goals
• Protects Business Operations and organization by keeping information confidential

This job description in no way states or implies that these are the only duties performed by the employee occupying this position. Employees will be required to perform any other job-related duties assigned by their supervisor or management.

• Associate degree preferred and/or two to four years of experience.
• Knowledge of Healthcare environment desired
• Proficient in relevant computer applications such as MS Word, MS Excel, MS PowerPoint, and Epic, * Accurate keyboard skills and proven ability to enter data at the required speed, and knowledge of correct spelling, grammar and punctuation
• Strong computer skills and experience working within databases
• Excellent communication skills, both written and verbal, to interact with the business in gathering requirements and presenting data from the reports
• Well-organized, action and results oriented team player with exceptional time management skills to support multiple initiatives simultaneously in a fast-paced environment with accuracy
• Ability to establish and articulate results with high attention to detail and the ability to prioritize.
• Good presentation skills with solid communication capabilities and practices, both oral and written
• Ability to ensure processes comply with HIPPA regulations

The Clearinghouse is a statewide system managed by the Agency for Health Care Administration (AHCA) and is designed to help protect children, seniors, and other vulnerable populations while streamlining the screening process for employers and applicants.