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About the Role

GDIT is seeking a Systems Analyst Associate to administer Electronic Data Interchange (EDI) activities, including COBA Crossover Process, Section 111, and Data Sharing Agreements. This role involves troubleshooting direct file transfer and COBSW issues, providing front-line customer service and education via the EDI Hotline, and adhering to call center metrics.

Responsibilities

Monitor file processing between mainframe and distributed systems, compiling error reports and communicating with Trading Partners, programmers, Insurers, Employers, Medicare contractors, and CMS to resolve issues.
Interact directly with stakeholders to resolve issues within strict Service Level Agreements (SLAs), returning all emails, voicemails, and work items within 2 business days.
Provide front-line support on the EDI Hotline, maintaining strict Schedule Adherence, monitoring AUX code limits, and minimizing missed calls.
Work independently on assigned business partners with minimal supervision.
Troubleshoot and facilitate the resolution of data file transmission and transaction errors, verifying communication links and interfaces.
Manage daily workflow queues across multiple systems (MIRA, BCRS, ECRS) and maintain internal tracking spreadsheets.
Work with management to establish, document, and maintain EDI procedures by identifying errors, taking corrective action, and reconciling EDI transactions.
Oversee and maintain the EDI Inquiry Problem database, evaluating issues through to resolution with detailed documentation.
Conduct regular audits of EDI transactions to determine accuracy and areas for improvement, maintaining EDI maps and business rules for HIPAA validation software.
Monitor daily receipts and processing of claim files from Medicare contractors, troubleshooting and resolving data transmission or content problems.
Perform analysis based on claim crossover inquiries related to eligibility files and billing.
Interface with and/or lead management and technical application teams and business partners to define project specifications, timelines, and deliverables through primary account ownership.
Identify new business opportunities, systems, processes, and possible improvements to present to management.
Establish and maintain business relationships with internal and external trading partners and business partners.
Train customers and internal employees on data exchange processes and systems.
Perform other duties as directed by management in support of the organization/EDI mission.
Coordinate tasks with BCRC partners to ensure correct EDI information formatting for accurate Response File creation.
Assist in User Acceptance Testing of system enhancements before production deployment.
Assist in the development and updating of educational material for the COBSW Site for all EDI Activities.
Work closely with external customers to ensure a smooth transition from testing to production.
Respond to inquiries from CMS Central Office and CMS Regional Office staff.

Requirements

Experience as a Customer Support Specialist or similar CS role.
Strong analytical and research skills.
Ability to communicate effectively with all levels of management and communities.
Excellent verbal and written communication skills.
PC skills including working knowledge and proficiency with Microsoft Office products.
Designated office space in order to work from home.
Experience researching and analyzing file layouts, specifically 837 flat files.
Knowledge of health insurance concepts such as Medicare Part A, B, C and D.
Knowledge of health insurance concepts and/or experience in HIPAA EDI 837.
Knowledge of data processing systems and hardware particularly personal computers.
Knowledge of Professional and Institutional files structures and guidelines.
Knowledge of telecommunication data delivery methods and telecommunication software and concepts such as NDM (Connect Direct), FTP and dedicated connections.
Experience in the implementation of maintenance of trading partner accounts in a high-volume, high-paced operation using flexibility in terms of managing many accounts with unique requirements.
Working knowledge of EDI data translation/validator support, i.e. Sterling Gentran/Ingenix Faciledi a plus.
Excellent interpersonal and customer relationship skills with the ability to work in a very fast paced environment.
Ability to learn new concepts quickly and independently while maintaining effective communications with other team members.
Past experience working remotely in an at-home office.

Skills

Analytical Research
Customer Service
Effective Written Communication
Verbal Communications

Location

Any Location / Remote
Remote

Work Type

Remote
Full-time

Experience Level

5 + years of related experience

Education Level

Bachelor’s Degree or appropriate combination of post-secondary education and relevant work experience.

Salary/Compensations

$55,806 - $74,750

Benefits

Medical plan options
Health Savings Accounts
Dental plan options
Vision plan
401(k) plan with company match
Full flex work weeks
Vacation time
Sick time
Personal time
10 paid holidays
Paid parental leave
Paid military leave
Paid bereavement leave
Paid jury duty leave
Paid Family Leave (up to 160 hours)
Short-term disability benefits
Long-term disability benefits
Life insurance
Accidental death and dismemberment insurance
Personal accident insurance
Critical illness insurance
Business travel and accident insurance

About the Company

GDIT is a global technology and professional services company that delivers technology solutions and mission services to every major agency across the U.S. government, defense and intelligence community.
Our 26,000 experts extract the power of technology to create immediate value and deliver solutions at the edge of innovation.
We operate across 50+ countries worldwide, offering leading mission-ready capabilities in AI, cloud, cyber and software development.

Equal Opportunity

Equal Opportunity Employer / Individuals with Disabilities / Protected Veterans