Business Analyst - EDI

6 days left

Minneapolis, Minnesota
Feb 05, 2021
Mar 14, 2021
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.


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.



ABOUT UCARE UCare offers Medicare, Medicaid, Individual and Family health plans - powered by the hardest working people in the industry. Our people powered teams de-complicate, advocate and always go the extra mile to help our members. We serve with integrity, compassion and commitment to do right by members, providers and government partners. Above all, we come to work excited to provide members a path for the best health of their lives.

WORKING AT UCARE Working at UCare is more than 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. Employees join UCare and stay because of the opportunity to have a purpose-driven job.

Our strong culture has established UCare as a Star Tribune Top 150 Workplace for 11 consecutive years since the awards program began. It's a culture that embraces innovative ideas, strategic partnerships, and exemplary customer and provider experiences. Working at UCare is being a part of a people powered team dedicated to making a real difference in the lives of our members and communities.


Position Description This position is a subject matter expert in EDI and related-areas and collaborates with business and technical stakeholders, and external trading partners to support execution of all EDI-related process and technical optimizations and operations. Act as department point-of-contact for cross-functional projects, workgroups, and committees. Serve as liaison and subject matter expert between the EDI and Technical Team and other CCO teams and departments within UCare. Monitor data transactions and operations, conduct audits, and research and resolve escalated issues. Elicit and document requirements; make recommendations for change in order to improve provider and/or member experience and enhance department efficiency. Support the development of data exchange solutions, interfaces and processes, and ensure requirements and solutions conform to departmental, corporate, industry, and government standards as specified.

• Collaborate with internal and external partners on feasibility of technical solutions, quantify and document business value or benefits. Assist with the implementation and expansion of UCare's automated systems as it relates to electronic interfaces. Participate in the development and implementation of departmental policies and procedures (P&Ps) to ensure efficient delivery of service.

• Conduct analysis to ensure completion, accuracy, and efficiency of processed data. Monitor the EDI transaction process to ensure that transactions are processed accurately and on schedule, and proactively troubleshoot errors and systemic issues. Audit data to validate information supplied to and from providers and trading partners.

• Develop and maintain trading partner requirements and supporting documentation and develop internal and external communications with trading partners for EDI-related processes, projects, issues, and initiatives.

• Provide ongoing assistance to software developers and testers to provide requirements and guidance, resolve defects during development and testing, and perform User Acceptance Testing for any EDI projects or processes.

• Support EDI Project Teams as the primary EDI subject matter expert and collaborate with business and technical stakeholders to perform analysis, define business requirements, and implement innovative solutions that solve EDI-related business problems.

• Develop and maintain reporting that solve business problems or meet desired business objectives.

• Develop and maintain EDI-related policies and procedures consistent with the goals and objectives of the organization. Supplement policies and procedures with functional and process level instruction and illustration. Communicate changes in policies and procedures to team and management in a timely manner.

• Ensure department turnaround times are met by responding to daily internal and external customer questions and concerns.

• Review, approve, and trigger bi-weekly payable runs for the claims adjudication system, including monitoring the process to ensure payable run completes accurately and timely.

• Other projects and duties as assigned.

Bachelor's degree in business, IT or related field; demonstrated experience may be considered.

Required Experience
Three years of experience in healthcare, two years of experience with EDI transactions, specifically HIPAA/EDI X12 v5010 healthcare-related EDI file formats. Familiarity with regulatory requirements associated with EDI. Familiarity with commonly used EDI concepts, best practices, and procedures within the health care industry.

Preferred Experience
Experience in healthcare business processes, claims, enrollment, and claim payment. Experience working with HealthRules or similar claims adjudication platform. Experience with Electronic Data Interchange claim systems and clearing houses. One year of experience working with project teams, and knowledge of waterfall and Agile project life cycle.

THE UCARE DIFFERENCE The UCare difference is our people power - employees actively working on the behalf of our members to get them access to the health care they need. We value and respect each individual's ideas and contributions, and provide the freedom to grow both personally and professionally. We are centrally located, and offer onsite education, equipment and wellness resources, and a myriad of volunteer activities. If you're looking for an inclusive environment that celebrates your people power, 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.

JOB POST DATE: 02/04/2021

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