Demo

Sr. Professional Business Analyst

Educology Solutions
Washington, DC Full Time
POSTED ON 2/9/2025 CLOSED ON 5/7/2025

What are the responsibilities and job description for the Sr. Professional Business Analyst position at Educology Solutions?

ESI is seeking a Healthcare Technical expert in multiple solution sets and X12 transactions, an implementation manager, and / or a support manager. From a solution standpoint, independently represents multiple EDI & QNXT (Administrator) Data components through all phases of the system development life cycle. Represents these solutions to customers, designing customized instances and implementing these solutions. Leads a group of 3-5 resources through an EDI solutions implementation or through ongoing support of an existing customer site. Demonstrates both technical and business prowess in the solution sets they represent. Continues to increase their technical expertise across all EDI & QNXT (Administrator) Data components, into Integrated Solutions areas, and into other Implementation Practice groups to aid in integration efforts. Also continues to increase their leadership skills through experience and additional training and education. Expert in the field of EDI Healthcare transaction sets.

Duties & Responsibilities :

  • Analyzes, models, designs, develops and implements EDI & QNXT Data components and X12 Transaction Sets for Medicaid sites.
  • Designs, develops and implements customized functionality to accommodate business processes related to EDI & CEF Data components.
  • Identifies the need for and develops new EDI & QNXT Data functionality to accommodate new business processes and procedures as they are introduced to the solution.
  • Assists and mentors peers with understanding EDI & QNXT Data components, technical architecture, custom development, and operations support.
  • Assists all other groups involved in integration efforts across the practice that involve EDI & QNXT Data.
  • Represents the EDI and QNXT Data group as a new implementation lead or existing customer support lead, managing junior Implementation Practice resources.

Knowledge / Skills / Abilities

  • In depth knowledge of HIPAA / EDI X12 5010 healthcare-related transactions including 270-271, 276-277, 278, 820, 834, 835, 837, TA1, 999, 824, and 6020 275 / 277RFAI
  • o Expertise in both inbound and outbound 834 transactions and knowledge of enrollment in a Medicaid environment is preferred.

  • In depth knowledge of EDI applications including the EDI Gateway, Edifecs suite of tools, Microsoft SQL Server Management Studio (SSMS), and other applications in support of EDI processing
  • In depth knowledge of QNXT Administrator and QNXT Connect
  • Fluent with commonly used EDI concepts, practices and procedures within a heath care field
  • Medicaid domain knowledge
  • Expert knowledge of industry standard health data code sets such as ICD-9 / ICD-10, CPT / HCPCS, revenue codes
  • Knowledgeable with regulatory requirements associated with 5010 and ICD-10
  • Specific knowledge of claims and / or Authorizations in a Medicaid environment
  • Possesses analytical and creative problem-solving skills
  • Excellent verbal and written communication skills
  • Ability to abide by policies
  • Ability to maintain attendance to support required quality and quantity of work
  • Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)
  • Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers
  • Job Qualifications Required Education :

  • Bachelor's Degree or equivalent experience
  • Required Experience :

  • Combined 12 years of health care, EDI, and project management experience.
  • Required Licensure / Certification :

  • N / A
  • Preferred Education :

  • Bachelors Degree in Computer Science or related field
  • Preferred Experience :

  • 12 years of Medicaid, CEF solution sets, and project management experience.
  • Preferred Licensure / Certification :

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