Edi Specialist Jobs

Job Summary:

The EDI Specialist works with the company’s Electronic Data Interchange program, facilitating the establishment of new customer/partner relationships within our EDI environment, including documenting requirements, testing solutions, and ensuring successful implementations.

Duties and Responsibilities:

• Work directly with the EDI Coordinator to identify and address problems as they arise reporting levels of activity using key established metrics for senior management.
• Conduct and lead on all end-to-end testing phases with Trading Partners and Business Users.
• The primary objective of this position is to organize, implement and enforce correct data collection and distribution policies and methods.
• Maintains active relationships with internal and/or external stakeholder to develop business requirements.
• Root cause analysis of any production issue.
• Participates in meetings with stakeholders to gather and document requirements and explore potential solutions.
• Works with development team to develop, define application scope and objectives and prepare functional and/or technical specifications to accommodate business processes related to EDI.
• Identify, recommend and implement process improvements in support of the EDI system.
• Analyzes and classifies complex change request and identifies and documents possible system code enhancements.
• Assists in creating basic test scenarios to be used in testing the business applications in order to verify that client requirements are incorporated into the system design.

Required Knowledge, Skills, and Abilities:

• EDI health care transaction processing for eligibility, clinical, claims, accumulator & provider X12 data.
• Pay close attention to detail in all aspects of the job.
• Follows instructions, responds to direction, and solicits feedback to improve.
• Maintain confidentiality and discretion.
• SQL/DB management environments including Microsoft SQL Server and PostGREsql databases.
• Specific knowledge of claims, enrollment, and /or Authorizations.
• Solid working knowledge of standard computer applications including MS Word, Excel, Outlook, and PowerPoint.
• Knowledge of Agile Methodology.
• Demonstrate a collaborative interaction with peers to reach a common goal as well as be a resource to team members and internal/external customers.
• Bachelor’s degree in computer science, mathematics or informatics or equivalent experience.
• Prioritize and plan work activities to use time efficiently.
• Knowledgeable with regulatory requirements associated with 5010 and ICD-10.
• Open to other’s ideas and exhibits a willingness to try new things.
• Adapt to changes in the work environment, manage competing demands; able to deal with frequent change, delays, or unexpected events.
• Knowledge of industry standard health data code sets such as ICD-9/ICD-10, CPT/HCPCS, revenue codes.
• Eldorado Javelina claims management platform experience a plus.
• Act in such a way to instill trust from management, other associates, as well as customers.
• 10+ years of healthcare insurance industry claims and eligibility administration experience.
• Work effectively as part of a team to achieve established outcomes. Understand other’s roles and empower one another to take responsibility to be successful. Demonstrate a collaborative interaction with peers to reach a common goal.
• Make decisions using available resources and sound judgment.
• Communicate clearly and professionally with internal and external customers; including the ability to explain technical detail with non-technical counterparts.
• Identify and resolve problems in a timely manner, gather and analyzes information skillfully.
• Direct / Hands-on experience with EDI Healthcare X12 Transactions (837, 834, 835, 270/271, 278, 276/277, 999).
• Demonstrate accuracy and thoroughness; monitor work to ensure quality.

Physical Demands -The physical demands described here are representative of those necessary for an employee to successfully perform the essential functions of this job. Reasonable accommodation can be made to enable individuals with disabilities to perform the essential functions.

• Constant: Specific vision abilities required by this job include close vision requirements due to computer work for full shift
• Occasional: Lift and/or move up to 10 pounds
• Constant: Talk, hear, speak, and use hands and fingers to operate a computer, telephone, keyboard/mouse; occasionally move about the office
• Constant: Regular, predictable attendance is required
• Constant: While performing the duties of this job, the employee is regularly sitting for the full shift.

Work Environment - The work environment described is representative of what must be met by an employee successfully perform the essential functions of this job.

The physical environment is indoors in a controlled climate, office setting. The noise level may be low to moderate.

The duties described are representative, but not restrictive of tasks that may be assigned or of the abilities required to do the job. The description is subject to change at any time. Other related duties may be assigned. This description does not alter the at-will status of employment.

Pay may vary based on location. Offers will be adjusted based on an individual's experience, education, and other job-related factors as permitted by law.