Company :Highmark Inc.
Job Description :
This job provides analysis and support to both internal and external customers on EDI, OCR and CSO mail operation transaction related issues. Provides analysis and technical support for UCD web portals for members , providers and producers. Responds to external EDI inquiries from providers and EDI Trading Partners, external inquiries from OCR and CSO vendors and inquiries from internal departments related to the EDI, OCR, CSO and Claims Input. May help customers with connection protocols, etc. Supports development, implementation and testing of systems handling electronic transactions (EDI, OCR and CSO) and web services. Determines need for changes, updates and improvements. Ensures transactions and processes are in compliance with corporate and governing regulations.
- Detect, investigate research, analyze and resolve problems in the EDI, OCR and CSO arenas.
- Review, analyze, recommend and implement EDI, OCR and CSO related projects, system changes, and enhancements in accordance with regulations, standards and corporate requirements.
- Collect and provide analysis related to EDI, OCR and CSO performance
- Provide technical information for internal/external audits, management controls, and system/flow/process documentation and education.
- Detect, investigate research, analyze and resolve problems in the web services arena.
- Other duties as assigned or requested.
- High School Diploma/GED
- 3-5 years of relevant, progressive experience in the area of specialization. Exempted experience requirements effective August 2016
- Bachelor Degree
- Experience in the use of Access and SAS (and any other systems/tools used within the department)
- Strong verbal and written communication skills and ability to multi task (all levels)
- Independent thinking and decision making, strong analytical skills
- Knowledge of the HIPAA transactions, UCD commercial, partner and government claims/customer services processes and UCD web services
- Knowledge in using reporting applications (such as Access, SAS, etc.)
- Knowledge in using Word, Excel, Powerpoint and Visio
- Knowledge in Business Process Modeling
SCOPE OF RESPONSIBILITY
Does this role supervise/manage other employees?
Is Travel Required?
Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.
Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
EEO is The Law
For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org