Senior Analyst Informatics
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.
The typical pay range for this role is:
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.
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
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.
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