Company :United Concordia DentalJob Description : 

JOB SUMMARY

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.

ESSENTIAL RESPONSIBILITIES

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 performanceProvide 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.

QUALIFICATIONS

Minimum

High School Diploma/GED3-5 years of relevant, progressive experience in the area of specialization. Exempted experience requirements effective August 2016

Preferred

Bachelor DegreeExperience 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

Skills

Knowledge of the HIPAA transactions, UCD commercial, partner and government claims/customer services processes and UCD web servicesKnowledge in using reporting applications (such as Access, SAS, etc.)Knowledge in using Word, Excel, Powerpoint and VisioKnowledge in Business Process Modeling

Required:

** Due to Department of Defense (DOD) contract requirements, the incumbent who fills this position must be a US citizen, and must also pass a background check **

Position Type:  WFA – Work from Anywhere

100% - Remote

SCOPE OF RESPONSIBILITY  

Does this role supervise/manage other employees?      

No

   

WORK ENVIRONMENT

Is Travel Required?

Yes- 0 - 25%    

Referral Level 1:

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

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.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability. 

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