System Operations Analyst

Position summary

Qualifications

• An associate degree is preferred and/or two to four years of experience.
• Knowledge of the healthcare environment is desired.
• Proficiency in relevant applications, including MS Word, MS Excel, MS PowerPoint, and Epic.

Essential duties and responsibilities

• Processes inbound and outbound feeds for eligibility, claims, maximum out-of-pocket, health plan employer data, and other EDI files.
• Compiles and sorts source data, sets entry priorities, and enters data into EPIC Tapestry.
• Checks uploaded data for integrity issues and creates or executes reports for team-leader or manager resolution.
• Assists with EPIC claims, encounters, MOOP, eligibility, 835, and 837 file loads.
• Tests claims, eligibility, and MOOP loads, as well as the AP claim payment process.
• Reviews workflow documents, resolves discrepancies using standard procedures, and routes incomplete documents for resolution.
• Ensures EPIC Tapestry data loads are accurate and timely to support claims payment.
• Validates provider business details using industry websites, databases, and internal documents.
• Maintains data-entry procedures, monitors CRM requests, and updates system data according to guidelines.
• Follows policies and workflows, meets assigned deadlines, and keeps information confidential.

Skills and abilities

• Accurate keyboarding and data entry at the required speed, with correct spelling, grammar, and punctuation.
• Strong computer skills and experience working in databases.
• Strong written and verbal communication skills for gathering requirements and presenting report findings.
• Organization, time management, prioritization, attention to detail, and ability to support multiple initiatives.
• Ability to ensure processes comply with HIPAA regulations.

Work schedule

• The company is currently following a hybrid work schedule and reserves the right to change schedules based on business needs.

Physical demands and work environment

• The role regularly involves sitting, using hands, reaching, and talking or hearing; it may also involve standing, walking, bending, kneeling, crouching, crawling, and occasionally lifting or moving up to 15 pounds.
• The work environment may include office and outdoor settings and travel to other offices, including domestic travel.