The Business Information Consultant develops specifications and requirements for the submission of health care medical encounter data files which meet ANSI X12 data criteria, are HIPAA compliant, and meet state Medicaid and federal Medicare guidelines as expressed in companion guides and technical specifications. These include ANSI X12 transactions 837P, 837I, 837D, 835, 270, 271, 276, 277 and 999 for encounter reporting. Work on Medicaid encounters submission to Ohio, Indiana and NJ state and reconcile the remits received from state. Analyze pends, rejects, completeness, accuracy reports and share with stakeholders. Gather business requirements to eliminate internal exception as well as external exception codes. Work with Encounters IT team to assist with change requests which includes preparing the requirements, testing documentation, completing the mapping, and assisting with system and state testing. Produce high quality requirement specifications to support systems functional design development. Develop and analyze business performance reports (e.g. for claims data, provider data, utilization data) and provide notations of performance deviations and anomalies. Provide analytic consultation to other business areas, leadership, or external customers. Analyze data and summarize performance using summary statistical procedures. May require taking business issue and devising best way to develop appropriate diagnostic and/or tracking data that will translate business requirements into usable decision support tools. Minimum Requirements: Bachelor’s degree in Computer Science, or related. Five (5) years in any occupation with IT experience. Additional Requirements: Five (5) years in any occupation with IT experience must include: SQL and/or any other similar query language; Defect tracking tools. Health care data models. Encounter reporting using the ANSI X12 standards with delegated vendors such as transportation, dental, vision, and chiropractic; End-to-end testing from source data through enterprise applications. Edifecs EM application’s technical and workflow experience. Experience in different X12 transactions and reconciliation of data. Facets data model and application experience. ALTERNATE EDUCATION/EXPERIENCE REQUIREMENTS: Employer will accept a Master’s degree in Computer Science, or related, and three (3) years in any occupation with IT experience. Must have skills listed above.
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