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Job Details

CVS Health

Senior Analyst Informatics



Full Time

On Site


Texas, United States

Job Description
Aetna Better Health of Texas is looking for an EDI specialist to oversee process performance and provide technical expertise in ensuring that all regulatory requirements are met on the delivery of HIPAA compliant 278 (prior authorization), 835 (payment files) and 837 (claim/encounter) files.
Individual in this role will coordinate with different teams to ensure any errors received upon submission of EDI data to regulator is resolved timely and accurately. Utilize reporting framework to work internally and with vendors to ensure timely resolution of error inventory. Will manage any changes to these processes from initiation through completion.
Assists in other projects related to files processing and technical delivery to different teams.

Pay Range
The typical pay range for this role is:
Minimum: 43,700
Maximum: 100,000

Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.

Required Qualifications
 Prior working experience in EDI files in 278/835/837 formats.
 1+ years experience of working knowledge of SQL – able to write queries from scratch and extract data for reporting, validation.
 Ability to review regulator documentation, companion guides and X12 industry standards to interpret requirements, remove ambiguity and provide clear technical direction.
 Prior experience working with IT and business teams, problem solving and driving to a solution.
 Proficient in using Office products – Excel

Preferred Qualifications
 Background in Texas Medicaid operations a plus.
 Familiarity with database and visualization tools like Power BI, SSRS
 Prior Medicaid experience preferred.

 Bachelor's Degree in Information Systems, Computer Science/related field or equivalent working experience.

Business Overview
Bring your heart to CVS Health Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.