Regulatory & EDI Analyst
Location: , United States
Share:
Description
Regulatory & EDI Analyst
Your role on the team:
Reporting to the Compliance Team Lead, the Regulatory and EDI Analyst is responsible for overseeing, incorporating, and coordinating regulatory updates in the Frontline Medicaid application and maintaining Quality Control for EDI transactions and program management. The main objective for this position is to ensure that the Frontline Medicaid product continues to stay in compliance with regulatory changes surrounding EDI transactions in a timely manner and to manage the quality control process of all Medicaid related system settings. This role also requires the submission of EDI files on behalf of clients and ensures that regulatory changes are implemented to continually improve new and existing operational Client Success efficiencies while ensuring an easy-to-do business with software experience.
You can expect to:
- Review state Medicaid regulations and monitor companion guides on regular basis to ensure Frontline Medicaid system compliance is always up to date
- Analyze Medicaid policy and provide guidance on how to update or configure Frontline’s Medicaid claiming applications
- Processes EDI transactions in assigned Medicaid states, including 270/271, 277/276, 837/835 and 999 files
- Configure Medicaid regulatory data including rates, billing unit limits, procedure codes, diagnostic codes etc.
- Develop, refine and maintain a quality control process for all Medicaid claiming engines to ensure compliance with the latest regulations
- Review all Medicaid system reporting to ensure accuracy of results and identify anomalies in claiming or eligibility levels
- Manage the ICD-10 diagnostic code annual update by updating the diagnostic codes/descriptions and assignments
- Project manage claiming issues, including regulatory changes, resolutions to increased denials, eligibility level fluctuations, state system access, and file formatting errors
- Communicate with various departments to keep Frontline staff abreast of regulatory changes
- Monitor eligibility and claiming dashboard to ensure transactions are running on schedule for all clients
- Work directly with the Product Team to communicate system enhancements for regulatory reasons or report bugs in the claiming applications
- Analyze regulations in emerging states and ensure regulatory Medicaid compliance with new system development with the Compliance Team
- Process and track all annual vendor certifications and submissions
- Assist with new vendor relationship enrollment with state Medicaid agencies and maintain documentation for ERA
- Develop state contacts to clarify regulations as needed
- Attend state conferences and webinars on new state regulations as needed and communicate to all relevant departments
- Research denials and resubmit denied services as necessary
- Issue announcements directly to clients regarding regulatory changes
- On occasion participate in direct client calls to clarify Medicaid regulations
- QC Frontline systems on a regular basis including, rates, procedure code limits, diagnostic code expirations, claiming validations
- Maintain internal guidance on pertinent Medicaid policy
What you bring to the role:
- Ability to build relationships and communicate effectively
- Positive, can-do attitude with the ability to succeed in a fast-paced work environment
- Ability to research and analyze regulations in emerging states and ensure regulatory Medicaid compliance
- Medicaid experience within an education/school context is a plus
This role requires:
- Bachelor’s Degree in related field required
- Technical proficiency, communication and organizational skills are top strengths
- 2+ years Medicaid experience
Who we are:
Frontline Education is a pioneer of school administration software purpose-built for K-12 districts. We provide innovative, connected solutions for student and special programs, business operations, and human capital management with powerful data and analytics to empower educators and administrators. We earn the trust of K-12 leaders across the U.S. by serving as a consistently high-performing, forthright partner of school districts through every dimension of the company.
We're a group of unique and talented individuals that love what we do. We've been lucky enough to land jobs with a rapidly growing tech company that supports an appreciative and friendly customer base. We work hard to make our customers happy, but we like to have a good time in the process. We are a company that strives to think in terms of “we” instead of “me.” We believe in the philosophy of servant leadership and that it’s all about putting others first. We also value the balance between family and work.
Frontline embraces diversity, equity, and inclusivity. We are intentionally building a workplace that respects, supports, and values the identities of all our employees. We believe this to be foundational in developing a strong community in our company. Frontline Education is an equal opportunity employer and we do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.
The perks of being a Frontliner:
Frontline offers a competitive compensation package including a base salary, rewarding bonus structure, 401k match, ESPP, and personalized PTO! Our company growth has created a promising environment for career advancement and rewarding challenges. We offer a tuition reimbursement program for eligible college credit coursework available to employees depending on their status and length of employment.
Share:
