Type of Requisition:
Regular
Clearance Level Must Currently Possess:
None
Clearance Level Must Be Able to Obtain:
None
Suitability:
No Suitability Required
Public Trust/Other Required:
None
Job Family:
Systems Analysis
Job Description:
GDIT is seeking a Sr. Systems Analyst with experience as an Electronic Data Interchange Subject Matter Expert (EDI SME) to enhance and maintain a healthcare eligibility benefit application for Centers for Medicare and Medicaid Services (CMS).
The Sr. Systems Analyst will support strategic objectives by analyzing business processes to ensure compliance with CAQH CORE Operating Rules, HIPAA and X12 standards. He/She will gather data and evaluate requirements to implement solutions, bringing expert knowledge of EDI transactions and HIPAA code sets to perform complex analysis of X12 standards.
Onsite in Baltimore preferred, but remote candidates will also be considered!
Duties and Responsibilities
Act as subject matter expert for internal BESST teams and external stakeholders regarding health benefit eligibility requests/responses on EDI X12 270/271 transactions.
Resolve) issues related to production EDI transactions
Analyze requirements of the HETS systems relative to upcoming X12 Standards version
Interpret regulatory requirements from various governmental entities, such as Centers for Medicare and Medicaid Services (CMS), and implement system requirements according to these specifications
Ensure HIPAA compliant code sets are applied in HETS core systems
Act as the POC/representative at three annual conferences
Maintain operational procedures according to HIPAA guidelines and maintain documentation of HETS and EDI requirements
Diagnose and resolve problems with EDI production
Requirements
Bachelors degree in Information Technology, Information Systems, or related discipline
10+ years of relevant experience, to include one or more of the following:
X12 transactions: 820, 834, 274, 270/271, 276/277 835, 837 P/I
EDI mapping software and XML Structures
CAQH CORE Operating Rules
Working knowledge of one or more of the following:
Health Reference Data: Diagnosis Codes (ICD-10), Procedure Codes (CPT, HCPCS), National Drug Codes (NDC), Healthcare Provider Identifiers and Taxonomy (NPI), Medicare Provider Enrollment, Chain, and Ownership System (PECOS), Clearinghouses and Trading Partners,HIPAA compliant electronic transactions, CMS applications.
Knowledge of Medicare programs and/or experience in a healthcare environment
Experience developing business requirements
Experience with root cause analysis and troubleshooting
TRAVEL Required: Attendance at Annual X12 Conferences three times per year.
Preferred
Strong knowledge of DB2 database and SQL scripts
Experience working in an Agile software development project
Experience with AWS Cloud Management
Experience in Waterfall and Agile Scrum SDLC methodology
Scheduled Weekly Hours:
40
Travel Required:
Less than 10%
Telecommuting Options:
Onsite
Work Location:
USA MD Baltimore
Additional Work Locations:
COVID-19 Vaccination: GDIT does not have a vaccination mandate applicable to all employees. To protect the health and safety of its employees and to comply with customer requirements, however, GDIT may require employees in certain positions to be fully vaccinated against COVID-19. Vaccination requirements will depend on the status of the federal contractor mandate and customer site requirements.
We are GDIT. The people supporting some of the most complex government, defense, and intelligence projects across the country. We deliver. Bringing the expertise needed to understand and advance critical missions. We transform. Shifting the ways clients invest in, integrate, and innovate technology solutions. We ensure today is safe and tomorrow is smarter. We are there. On the ground, beside our clients, in the lab, and everywhere in between. Offering the technology transformations, strategy, and mission services needed to get the job done.
GDIT is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status, or any other protected class.
