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CNO Financial Group Senior EDI Compliance Analyst in Philadelphia, Pennsylvania

CNO Financial Group Enterprise Operations Seeks Our Next Sr Compliance & EDI Analyst!

The Senior Compliance & EDI Analyst works with minimal direction and is responsible for monitoring, researching and resolving or coordinating system enhancements or changes related to vendors, business partners or regulations. This includes monitoring of activity, contracts and inquiries with clearinghouses and Electronic Data Interchange (EDI) trading partners to identify trends and issues.

Key Job Responsibilities and Accountabilities:

  • Act as primary liaison with Centers for Medicare/Medicaid Services (CMS) for monitoring updates to laws and regulations.

  • Monitor alerts, review for impact to the business and work with the department to ensure proper changes are made to comply with changes or alert business to processing changes.

  • X12 Electronic Transactions and Affordable Care Act (ACA) Regulation reviews; monitor and review claim transaction details for changes to claims processing and coordinate system and/or process modifications with the Legal, Compliance, IT and claims leadership to ensure correct interpretation of requirements are followed.

  • Coordinate testing for implementation of remit only 835 files, file fixes and patches. Complete system set up and testing of providers or clearing house to add to Electronic Remittance Advice (ERA) tables for remit only payments.

  • Review of transmission files for adherence to state specific claim requirements.

  • Act as primary liaison for claims data clearing houses and trading partners for processing and information sharing.

  • Works with IT to troubleshoot and/or define requirements for changes or improvements. Oversees the set up and monitoring of contracts and agreements and coordinates with business partners.

  • Claims Support: Work with claims support teams to monitor and support the Electronic Funds Transfer (EFT) process for claims.

  • In addition will work with claims to support the EO1 error reports for the Med Supp Crossover claims process.

Skills, Knowledge, and Abilities:

  • Solid knowledge and background in Health insurance claims and support systems and electronic data transactions (835, 270/271, 5010 format, etc.)

  • Good knowledge of organizational processes, and has an ability to support process improvements, system enhancements, and product introductions.

  • Strong written and verbal communication and listening skills.

  • Strong analytical and critical thinking skills to work through problems to a resolution.

  • Experience on cross-functional teams and training/mentoring others.

  • Strong time management skills.

  • Strong ability to multi-task and balance multiple priorities.

  • Analyzes detailed technical information and large volumes of data and presents conclusions in concise non-technical terms to business partners.

  • Strong knowledge of Microsoft Office and other business-related software.

  • Interfaces with internal business partners, 3rd party vendors (UFL) and Information Technology teams.

  • Trains and coaches on changes/impacts.

  • Solid understanding of business requirements and process flows, supporting development of test plans which are realistic and appropriate to the business.

  • Ability to learn quickly, work in a fast-paced environment and be flexible and adaptable to change.

  • Team-oriented with the ability to collaborate effectively with coworkers and project teams.

  • Works with stakeholders to ensure understanding and usability of new functionality.

  • Identifies opportunities, makes recommendations, and implements testing process improvements.

  • Supports training needs based on system enhancements or implementations.

Education and Experience:

  • Requires a Bachelors’ degree in Business Administration, Computer science, or other related field.

  • Requires a minimum of five years of work experience in health claims, with knowledge of HIPAA, ACA, and electronic transaction operating rules.

  • Attainment, or the ability to attain, of one or more of the following certifications is preferred: Certified Coding Associate (CCA), Certification of Capability in Business Analysis (CCBA), Certified Business Analysis Professional (CBAP), Certification in Business Data Analytics (CBDA).

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