Presbyterian Healthcare Services

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PROVIDER NETWORK ELECTRONIC DATA INTERCHANGE/eBUSINESS ANALYST

at Presbyterian Healthcare Services

Posted: 12/31/2019
Job Reference #: 13092

Job Description

  • Requisition ID
    2019-13092
    Category
    Analytics
    Location : Name
    Rev Hugh Cooper Admin Center
    Default: Location : City
    Albuquerque
    Default: Location : State/Province (Full Name)
    New Mexico
  • Overview

    Job Description
    Type of Opportunity: Full Time
    FTE: 1.000000
    Exempt: Yes
    Work Schedule: Weekday Schedule Monday-Friday

    Summary:
    Develop, coordinate and support the implementation of innovative eBusiness enhancement activities and tools to support departmental and organizational goals, and initiatives related to technology. Responsible for coordination, planning, and oversight of electronic data interchange (EDI) transactions including, but not limited to electronic claims (837), electronic remittance (835), and electronic funds transfer (EFT) in accordance with HIPAA transaction and code set standards.

    Responsibilities

    Responsibilities:
    *Serves as the health plan liaison in promoting eBusiness technology and electronic file transactions. Provides formal presentations in large provider and public forums on Presbyterians eBusiness initiatives related to provider electronic connectivity.

    *Assists providers with navigation and implementation for EDI transactions including electronic claims, electronic remittances, and electronic funds transfer. Department liaison for EDI related activities, i.e. testing, implementation, and upgrades adopting HIPAA transaction and code set standards.

    *Identify opportunities to enhance existing technology and explore alternative solutions to barriers in order to enhance provider satisfaction and adoption of eBusiness technology.

    *Serves as the health plan business contact for clearinghouse partners and other eBusiness vendors as well as a serves as a technical advisor for various work groups and committees throughout the organization.

    *Leads work groups, committees and implementation teams to facilitate provider acceptance and use of emerging technologies.

    *Remain unbiased and open minded when evaluating new technologies and alternative eBusiness solutions

    *Works with the Communications Coordinator to develop provider communications promoting eBusiness initiatives.

    *Monitors and evaluates eBusiness processes and reports to identify potential system failures and trends related to ECT, EDI/RA as well as any deviation in paper claims volume.

    *Assists in design enhancements to existing business systems.

    *Develops and manages business objectives and goal setting related to EDI technology and enhancements.

    *Serve as the provider community advocate for policy changes and government/regulatory mandates related to EDI transactions which have a direct impact on the provider community.

    *Performs other functions as required.

    Qualifications

    Requirements:
    Bachelors degree in Business, Computer Science, Healthcare or related field, or equivalent experience preferred. Two to four years experience in a healthcare and/or health plan setting preferred.

    Demonstrated ability to communicate effectively in person, via telephone and in writing with peers, providers, all internal departments and external partners. Demonstrated ability to conduct large forum presentations. Able to work under limited supervision, self manage work time and projects, resolve issues with minimal assistance. Requires strong organizational skills, and the ability to create, sort and analyze reports (Excel, Access, Microsoft Project, PowerPoint, etc) and system processes.

    Detailed knowledge of EDI technology and related industry standards

    Competencies and skills:
    Nonessential:
    * Analytics skills
    * SKILL-Microsoft Office
    * Planning and coordinating organizational change
    * Anticipating & Addressing Customer Needs
    * Educating Employees, Customers & Transferring Knowledge
    * Functioning as an Effective Contingent Member
    * Diagnosing & Resolving Problems
    * Acquiring & Applying Superior Skills to achieve Quality Outcomes
    * Functioning as an Effective Team Member
    * Organizational Skills
    * SKILL-Ability to pull detail reports out of systems.
    * SKILL-Demonstrated ability to communicate effectively in person and via telephone with members, employer groups, brokers, physicians, and physician office staff using strong dialogue and customer service competencies.
    * SKILL-Able to work under limited supervision, self manage work time and projects, resolve issues with minimal assistance.
    * SKILL-Written communication

    Benefits

    Benefits
    Benefits are effective day-one (for .45 FTE and above) and include:

    • Competitive salaries
    • Full medical, dental and vision insurance
    • Flexible spending accounts (FSAs)
    • Free wellness programs
    • Paid time off (PTO)
    • Retirement plans, including matching employer contributions
    • Continuing education and career development opportunities
    • Life insurance and short/long term disability programs

    About Us
    Presbyterian Healthcare Services is a locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, it is the state's largest private employer with approximately 11,000 employees.

    Presbyterian's story is really the story of the remarkable people who have chosen to work here. Starting with Reverend Cooper who began our journey in 1908, the hard work of thousands of physicians, employees, board members, and other volunteers brought Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system, serving more than 700,000 New Mexicans.

    We are part of New Mexico's history - and committed to its future. That is why we will continue to work just as hard and care just as deeply to serve New Mexico for years to come.

    About New Mexico
    New Mexico's unique blend of Spanish, Mexican and Native American influences contribute to a culturally rich lifestyle. Add in Albuquerque's International Balloon Fiesta, Los Alamos' nuclear scientists, Roswell's visitors from outer space, and Santa Fe's artists, and you get an eclectic mix of people, places and experiences that make this state great.

    Cities in New Mexico are continually ranked among the nation's best places to work and live by Forbes magazine, Kiplinger's Personal Finance, and other corporate and government relocation managers like Worldwide ERC.

    New Mexico offers endless recreational opportunities to explore, and enjoy an active lifestyle. Venture off the beaten path, challenge your body in the elements, or open yourself up to the expansive sky. From hiking, golfing and biking to skiing, snowboarding and boating, it's all available among our beautiful wonders of the west.

    AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.

    Application Instructions

    Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!