Job purpose
The EDI Specialist is responsible for facilitating all activities between the provider, clearinghouse and IT in order to establish connectivity for submitting claim files. They will work closely with Network Management, Contracting and Claims to ensure all appropriate data elements are transmitted for claims payment. They will also be responsible for creation and maintenance of associated companion guides and mapping business rules as well as monitoring throughput on all submitters and converting paper submitters to EDI
Duties and responsibilities
· Act as a liaison between the provider and IT to set-up providers submitting new claim files
· Coordinate set-up activities with selected clearinghouse to ensure proper steps are followed for an effective transition
· Validate post-implementation submissions to ensure file integrity and established business rules are applied
· Perform an outreach process to determine proper EDI submission method and customize based upon provider’s business needs
· Identify providers who submit paper claims to target for EDI implementation
· Publish monthly reports to illustrate EDI submission rates and related metrics
· Investigate identified claims in-load discrepancies and work with related billers or vendors to remediate issue
· Analyzing EDI 835 errors, coding, testing, debugging, documentation, modification and installation of all EDI processes
· Initiates, communicates and coordinates all EDI activities with trading partners
· Maintain documentation on procedures and processes
· Ensure compliance with HIPAA policies and procedures
· Ability to identify 835 program error resolution
· Designing, writing and testing new software programs in our company framework (.NET). These applications are primarily ‘rich’ client applications but may also be Web applications
Preferred Qualifications
· Excellent interpersonal skills at both an individual and team level
· Excellent written and verbal communication skills
· Minimum 5-7 years of recent SQL server 2005/2008/2012 development including complex triggers and views
· 2+ years of SQL reporting experience is preferred