Provider Enrollment EDI & Encounter Analyst

Minneapolis, Minnesota
Jun 27, 2017
Aug 10, 2017
Employment Status
Full Time

Health Care that Starts with You!

Join a truly mission-driven organization! Independent, nonprofit UCare is recognized as one of the Minnesota's leading health plans. We provide more than 225,000 members across Minnesota and western Wisconsin with the health coverage plans and services they need to maintain and improve their health. The innovative coverage we create makes a difference for Medicare-eligible individuals, individuals and families enrolled in Minnesota Health Care Programs, such as MinnesotaCare and Medical Assistance, and disabled adults with special health care needs. UCare is growing in size, membership, products, geographic coverage, and employees. We're an organization that's going places. Be part of a team that cares about you, be part of UCare.



At UCare, we deliver high-quality health coverage and services to help members of all ages maintain and improve their health. It's a big job that takes innovative ideas, strategic partnerships, and a commitment to doing the right thing. Above all, it takes a compassionate team that is dedicated to making a real difference in the lives of our members and our communities.


Working at UCare is more than just a career; it's a mission. A mission that defines us as professionals, unites us as an organization, and shapes how we interact with our members and each other. Our values of integrity, community, quality, flexibility, and respect permeate every aspect of our organization - from who we are and how we act, to what we do and how we do it. We owe our continued success to our employees who proudly embody our mission and values in everything they do.


Position Description

This position is responsible to lead the processing of EDI provider rejections and monthly DHS and CMS provider encounter errors. Establish and maintain working relationships with providers and Clearinghouses; as well as establish and maintain a relationship with DHS to ensure encounters are reviewed and resubmitted accordingly.

·Collaborate with internal and third party technical contacts to test, implement and expand UCare's automated systems as it relates to electronic interfaces. Participate in the development and implementation of departmental policies and procedures to ensure efficient delivery of service.

·Collaborate with software vendors, IT staff and outside government agencies to resolve system and interface programming related issues.

·Collaborate with UCare staff, DHS and CMS to ensure that monthly encounter reports are reviewed timely.

·Ensure practitioners and/or entities are registered through DHS accordingly. If not registered, submit registration on behalf of the practitioner and/or entity as necessary. Work directly with DHS as needed.

·Ensure practitioners and/or entities are registered through CMS for monthly reporting.

·Ensure department turnaround times are met and accurate. Handle daily internal and external customer questions and concerns via service forms, emails and phone calls.

·Participate in work groups surrounding both EDI and Encounter functions.

·Use Medicaid verification and OIG Exclusion verification systems such as Streamline Verify prior to setup to ensure that entities and/or practitioners do not have any sanctions against them.

·Other projects and duties as assigned


Associates degree in business or health care preferred; demonstrated work experience may be considered in lieu of degree.

Required Experience

Two years of EDI transaction experience, two years of relevant experience in health care related field. 

Preferred Experience

Experience in a clinic business office, insurance or HMO environment.  Experience working with AMISYS or similar claims application.  Technical claim system experience.  Knowledge of 5010 and WEDI rules preferred. Experience with Electronic Data Interchange claim systems and clearinghouses. System knowledge of SharePoint.


UCare is proud to be a recognized Star Tribune Top Workplace for the 8th consecutive year. As a part of our collaborative team, you'll experience the rewards that come with helping others and seeing the positive results of your hard work. We value and respect each individual's ideas and contributions, and give you the freedom to grow both personally and professionally. We are centrally located, and offer onsite education, equipment and wellness resources, a myriad of volunteer activities, and a number of other rewards. If you're looking for a welcoming environment that celebrates what you have to offer, helps you build on your strengths, and gives you the opportunity to truly make a difference, we invite you to apply.

As an Equal Opportunity/Affirmative Action Employer, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.





Enter a highly collaborative environment where people are truly engaged, and feedback is valued. You'll enjoy a competitive salary and benefits, as well as a host of other perks, including a nationally recognized wellness program, and a bright, open, award-winning office space in Northeast Minneapolis just minutes from major freeways and retail centers. At UCare, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.

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