Job Description
This position is a Subject Matter Expert for the HIPAA 270/271 Real Time Eligibility and Benefits EDI transaction. This position will join a team of other EDI SMEs who are responsible for maintaining the day to day operations and integrity of the 270/271 transaction as well as support ongoing strategy and business development.
Fundamental Components
• Familiarity with HIPAA, Electronic Data Interchange, Real Time Eligibility and benefit details.
• Familiarity with X12 Transaction Guidelines and industry standards
• Works with business and IT constituents across key functional areas/lines of business to understand potential project impact on the transaction, organization, align project work, and execute activities accordingly.
• Perform User Acceptance Testing of the 270/271 transaction, reviews results of QA testing and involvement with off hour system implementations.
• Presents to internal/external customers, constituents and business partners, strong business as well as systems knowledge and can perform reasonability checks.
• Perform issue analysis by utilizing system information, business knowledge and industry transactional guidelines. • Influences change or enhancements to business processes, policies and system infrastructure to improve information quality, availability and access.
• Develops and participates in presentation and consultation to existing and prospective customers, business partners and internal business areas on information services, capabilities and performance results.
• Proactively evaluates project activities, builds contingency plans, executes corrective action, and monitors issue resolution to mitigate risks such as scope and/or budget variances.
Background Experience
• 3-5 years related work experience.
• Familiarity with EDI • Familiarity with APLC – Agile and Waterfall
• Proven track record meeting project dates.
• Excellent communication skills, both written and verbal
• Ability to manage multiple priorities
• Proven ability to affect change
• Strong understanding of the healthcare industry and regulatory environment, including in-depth knowledge of medical and specialty products Demonstrated ability to effectively coordinate multiple projects simultaneously.
Education
Bachelor's degree or equivalent experience
Percent of Travel Required
0 - 10%
Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.