"Alerted.org

**Facility:** Health Plan

**City** San Diego

Department

Job Status

Regular

Shift

Day

FTE

1

Shift Start Time

Shift End Time

Bachelor's Degree

Hours** **:

Shift Start Time:

8 AM

Shift End Time:

5 PM

AWS Hours Requirement:

8/40 - 8 Hour Shift

Additional Shift Information:

Weekend Requirements:

As Needed

On-Call Required:

No

Hourly Pay Range (Minimum - Midpoint - Maximum):

$42.790 - $55.210 - $61.840

The stated pay scale reflects the range that Sharp reasonably expects to pay for this position.  The actual pay rate and pay grade for this position will be dependent on a variety of factors, including an applicant’s years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, other requirements for the position, and employer business practices.

What You Will Do

Under the direction of the Manager of EDI Management, the Systems Analyst-EDI Mgmt will use technical and analytic skills to complete monitoring, reviewing, developing, triaging, scheduling and mapping inbound and outbound data files for Sharp Health Plan. The Systems Analyst-EDI Mgmt will work with general Health Plan operational data sets including, but not limited to, eligibility, claims, provider, billing, capitation, financial and structural. The Systems Analyst-EDI Mgmt will work to streamline processes, create efficiencies and complete development within the file management space.

Required Qualifications

+ H.S. Diploma or Equivalent

+ 2 Years experience in a health care and/or health plan organization.

+ Experience with data communications standards, data processing, and system configurations.

+ Experience analyzing complex issues and/or requests to provide effective solutions with the ability to identify root cause, communicate options and propose solutions.

Preferred Qualifications

+ Associate's Degree

+ 2 Years Direct experience in project planning and system implementation.

+ Experience as systems analyst within a large Health Plan.

Essential Functions

+ File ManagementSystems Analyst-EDI Mgmt will be familiar with tools such as Snowflake and SQL as ways to create data files. Will need to be fluent in database tools to be able to use the data to create outbound data. (SQL queries, views, procedures)Familiar with standard file management practices and oversight tools.Will develop new files based on specifications provided by internal or external partners.Utilizes Epic Tapestry reporting toolset, inclusive of Cogito, Caboodle and Clarity, to deliver on business requirements to external partners.Provide expertise on file structure, specifications and format for a wide variety of file types.

+ Quality AssuranceEnsure that files created within the team are checked for quality and measured against another reliable source.Develop and implement quality checks on newly created file processes to ensure data integrity across both incoming and outgoing files.

+ Participates in other duties as assignedParticipates in special projects and other duties as assigned. These may include, but are not limited to, work groups, proposals, audits and back-up support for other departments.

+ Data ExchangeConfigures, oversees and monitors SFTP routing rulesTracks file movements and patterns to be able to report on abnormalitiesWorks with external partners on data quality concerns, specifically related to ANSI EDI file transactions.Familiar with business use of standard HealthCare file sets, including but not limited to 837s, 834s, 835s and related acknowledgements.

Knowledge, Skills, and Abilities

+ Demonstration of professional level of knowledge of health plan operations, health plan software configuration, enrollment and claim file processing and trading partner management, and data processing environments.

+ Familiarity with data communications standards and system configuration.

+ Working knowledge of hospital, physician and health plan operations.

+ Strong analytical and problem solving skills; ability to collect and conduct interactive data analysis.

+ Extensive knowledge of IDX, Facets, QNXT, Healthedge, HPS, and/or other administrative systems within the health plan insurance industry.

+ Excellent written and verbal communication skills, including interaction with senior management.

+ Ability to apply independent decision-making skills and work well under tight deadlines and multiple priorities.

Sharp HealthCare is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability or any other protected class