EDI Analyst

Molina Healthcare Inc., is among the most experienced managed healthcare companies serving patients who have traditionally faced barriers to quality healthcare-including individuals covered under Medicaid, the Healthy Families Program, the State Children's Health Insurance Program (SCHIP) and other government-sponsored health insurance programs. Molina has health plans in California, Indiana, Michigan, New Mexico, Utah and Washington as well as 21 primary care clinics located in Northern and Southern California with future plans in Ohio and Texas. The company's corporate headquarters are in Long Beach, California.

Job Overview

1. Work with clearinghouse(s), health plans, state representatives, providers, Claims Department and IT System Analysts on EDI claim and encounter files along with their associated business requirements. This includes coordinating testing, error analysis, acceptance of files and communication with all participants.

2. Document and maintain the business guidelines for EDI claims/ encounters for assigned health plan(s). Coordinate any necessary updates with the appropriate clearinghouse(s) in support of the health plan's/ state's requirements. Coordinate with state representatives regarding business errors relative to encounter submissions.

3. Set-up of trading partners on ePortal, exchange of the trading partner documentation/ communication with the various parties in conjunction with the HIPAA PMO.

4. Troubleshoot EDI claim/ encounter issues as needed. Provide results along with any additional requirements to the initiating parties.

5. Additional tasks, as assigned.

Requirements

Previous experience in a healthcare setting. Experience in managed care and Medicare preferred. Knowledge in claims and encounters processing, including state-specific requirements for HCFA1500 and UB92 submissions. EDI claims experience and knowledge in ANSI 4010 necessary. NSF, MCDS, and EZCAP format a plus. Good communication, documentation and organizational skills a must. MS Word, Excel, and SQL necessary. MS Project, Access, and Visio a plus.

Molina Healthcare offers competitive benefits and compensation package.

Molina Healthcare is an Equal Opportunity Employer (EOE).