Holista

• Assist in modifying and maintaining SQL queries using SQL Server Management Studio. • Support reporting initiatives and system enhancements. • Serve as backup to the EDI Analyst II during absences. • Attend internal and external meetings related to system builds and payer reporting. • Analyze 277/834/835/837/999 EDI files for trends and discrepancies. • Assist with AR analytics and revenue cycle performance reporting. • Support payer issue investigations and claim data validation. • Participate in system testing and validation for updates or changes. • Maintain documentation for reporting workflows and processes. • Collaborate with EDI & Operations Analyst on internal system efficiencies.

• Research and resolve all claims and authorizations exceptions using internal resources. • Provide communication to providers as necessary regarding the status of a claim or authorization. • Follow up with providers on all financial implications of reprocessed claims or authorizations. • Transport all claims entered by processors from image software to proprietary software for review. • Utilizing knowledge of system, research current queues of work to find claims requiring further research and correction. • Research and resolve any claim and authorization issues to determine best resolution. • Work with internal departments to resolve issues involving authorization or claim handling. • Recoup any overpayments to providers resulting from changes to a claim or authorization processing by posting to the provider account. • Log all claims and authorizations that cannot be resolved and send rejection letters to providers. • Using knowledge of authorizations, hold certain payments pending the outcome of client review. • Adjudicate claims and send for payments ensuring that all proper documentation is attached. • Complete daily audit of claims entered by Claim Intake representative. • Take any incoming calls from providers or members regarding authorizations, benefits, or claim status. • Provide backup to Accounts Receivable Assistant or Authorization Representative as needed. • Develop and/or communicate methods to improve productivity and efficiency. • Assist with gathering data for client audits. • Contribute to the team effort by accomplishing additional responsibilities as needed. • Assist with training of new staff members.

• Support daily EDI operations including monitoring claims submissions and remittance processing. • Assist with AR, claim corrections and authorization-related workflows. • Coordinate with Claims and Authorization departments in alignment with check runs. • Work closely with the EDI & Operations Analyst on special projects and system improvements. • Assist in reviewing 277/834/835/837/999 files for errors or inconsistencies. • Track payer issues and support documentation efforts. • Participate in testing for system updates when needed. • Maintain organized records of EDI transmissions and payer communications. • Provide operational support during peak workload periods.

What are important things that YOU need to know about this role? Technical Skills - Strong proficiency in SQL for querying, data analysis, and troubleshooting. - Experience working with EDI healthcare transactions, including: - 277 (Claim Status) - 834 (Enrollment) - 835 (Payment/Remittance) - 837 (Claims) - 999 (Implementation Acknowledgment) Work Environment - Remote position - Standard schedule: 8:00–4:00 or 8:00–4:30 PM CT Work Style - Highly self‑reliant with the ability to research answers, use available resources, and work independently with minimal oversight. - Strong problem‑solving skills and comfort navigating complex systems. What will YOU be doing for us? The EDI Analyst I supports the EDI Analyst II in system reporting, revenue cycle analytics, and payer data management. This role serves as the secondary technical resource and backup to the EDI Analyst II, ensuring operational continuity when the level II analyst is unavailable. The EDI Analyst works on assigned projects, participates in meetings, and assists with external vendor coordination under the guidance of the EDI Analyst II and Director of Operations. What will YOU be working on every day? - Assist in modifying and maintaining SQL queries using SQL Server Management Studio. - Support reporting initiatives and system enhancements. - Serve as backup to the EDI Analyst II during absences. - Attend internal and external meetings related to system builds and payer reporting. - Analyze 277/834/835/837/999 EDI files for trends and discrepancies. - Assist with AR analytics and revenue cycle performance reporting. - Support payer issue investigations and claim data validation. - Participate in system testing and validation for updates or changes. - Maintain documentation for reporting workflows and processes. - Collaborate with EDI & Operations Analyst on internal system efficiencies. What qualifications do YOU need to have to be GOOD candidate? Required Education, Skills & Qualifications - Bachelor Degree in Management Information Systems, Computer Science or related degree or equivalent work experience or equivalent years of internal experience. - Strong analytical and investigative skills - Working knowledge of CPT codes and medical billing - Understanding of Accounts Receivable processes - Familiarity with 277, 834, 835, 837 and 999 EDI transactions - Ability to communicate technical findings clearly - Ability to prioritize and manage multiple projects Required Software Proficiency - SQL Server Management Studio (intermediate) - Microsoft Access - Microsoft Excel - Microsoft Word - Visual Studio - Notepad++ The salary range and midpoint is listed below for your reference. Please keep in mind that your education and experience along with your knowledge, skills and abilities are taken into consideration when determining placement within the range. Compensation Range: $51,244 - $76,865 Compensation Midpoint: $ 64,054