Business Systems Analyst at HAYS in Raleigh, North Carolina

Job Description:

The final salary or hourly wage, as applicable, paid to each candidate/applicant for this position is ultimately dependent on a variety of factors, including, but not limited to, the candidate's/applicant's qualifications, skills, and level of experience as well as the geographical location of the position.


Applicants must be legally authorized to work in the United States. Sponsorship not available.


Our client is seeking a Business Systems Analyst in Morrisville, NC.


Role Description


1. Claims & Encounters Analysis (Inbound/Outbound 837)
• Analyze and review rejected claims using Edifecs platform and SpecBuilder
• Identify errors and provide feedback to provider relations for resubmission
• Skills: Understanding of 837 loops/segments/elements, Edifecs Smart-Trading platform, Availity Essentials, strong SQL skill
2. EDI Transaction - 270/271 Eligibility Benefits Inquiry
• Review and analyze eligibility inquiries and response
• Use Informatica and Apigee platforms to process and validate data
• Skills: Knowledge of eligibility loops/segments, Informatica, Apigee, strong SQL skills
3. EDI Transaction - 276/277 Claims Status Inquiry and Response
• Analyze claims status inquiries and responses
• Identify and resolve issues related to incorrect member information
• Skills: Knowledge of claims status loops/segments, strong SQL skills
4. Paper Claim Processing (FIS Vendor)
• Define rules for converting paper claims to electronic format
• Update rules as needed based on benefit changes or regulatory enhancements
• Skills: Knowledge of paper to electronic claim conversion
5. Member and Provider Matching Analysis/Enhancement
• Analyze claims for member and provider matching
• Recommend changes to matching logic based on industry expertise
• Skills: Understanding of member/provider matching logic


Skills & Requirements


• Strong understanding of EDI transactions and claims processing
• Proficiency in SQL and data analysis
• Knowledge of Edifecs Smart-Trading platform, Availity Essentials, Informatica, and Apigee
• Familiarity with CBH systems, including Connects and Flexicare
• Excellent problem-solving and analytical skills
Education/Experience: Bachelor's degree in a technical field such as computer science, computer engineering or related field required. MBA or other related advanced degree preferred.


Benefits/Other Compensation


This position is a contract/temporary role where Hays offers you the opportunity to enroll in full medical benefits, dental benefits, vision benefits, 401K and Life Insurance ($20,000 benefit).


Why Hays?


You will be working with a professional recruiter who has intimate knowledge of the industry and market trends. Your Hays recruiter will lead you through a thorough screening process in order to understand your skills, experience, needs, and drivers. You will also get support on resume writing, interview tips, and career planning, so when there's a position you really want, you're fully prepared to get it.


Nervous about an upcoming interview? Unsure how to write a new resume?


Visit the Hays Career Advice section to learn top tips to help you stand out from the crowd when job hunting.


Hays is committed to building a thriving culture of diversity that embraces people with different backgrounds, perspectives, and experiences. We believe that the more inclusive we are, the better we serve our candidates, clients, and employees. We are an equal employment opportunity employer, and we comply with all applicable laws prohibiting discrimination based on race, color, creed, sex (including pregnancy, sexual orientation, or gender identity), age, national origin or ancestry, physical or mental disability, veteran status, marital status, genetic information, HIV-positive status, as well as any other characteristic protected by federal, state, or local law. One of Hays' guiding principles is 'do the right thing'.
We also believe that actions speak louder than words.
In that regard, we train our staff on ensuring inclusivity throughout the entire recruitment process and counsel our clients on these principles. If you have any questions about Hays or any of our processes, please contact us.


In accordance with applicable federal, state, and local law protecting qualified individuals with known disabilities, Hays will attempt to reasonably accommodate those individuals unless doing so would create an undue hardship on the company. Any qualified applicant or consultant with a disability who requires an accommodation in order to perform the essential functions of the job should call or text 813.336.5570.


Drug testing may be required; please contact a recruiter for more information.


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#1169789 - Michal Mercier