EDI Specialist

Specific Duties/Requirements

• Requires an extensive knowledge of EDI Portal and managing inbound EDI enrollment file activity.

• Responsible for ensuring successful transfer of inbound EDI enrollment data to include troubleshooting/reconciliation of data integrity issues.

• Responsible for managing EDI file activity for high-profile/complex EDI client business (BPO, Shared Services, non-standard, etc.).

• Direct contact between EDI senders, clients, Account Management teams, Customer Experience teams, BizTalk/.Net teams, and project teams.

• Responsible for supporting project work within the business area (lead and/or participate in project meetings, sprint work, business requirement documentation, system upgrades, and business check-outs).

• Responsible for managing all robotic process automation (RPA) work for the business area.

• Responsible for providing support to the Department's Business Systems Analyst with client specific EDI enrollment testing.

Additional Job Responsiblities

• Assist in the development of user system documentation and desk level procedures.

• Manage daily team inventory activity and provide support/training/direction to Eligibility Specialist team members.

• Support enrollment related issues resolution/Enrollment Resolver Group participant.

• Organize/disperse team project work to other team members.

• Assist with manual enrollment processing for all lines of business.

• Support Member Enrollment System platform (to include development work, inquiries and EDI file activity)

• Meet departmental quality and production standards

• Other duties as assigned by the Leadership Team.

Knowledge Summary

• Ability to work with multiple business systems and have a general understanding of system design.

• Knowledgeable of Microsoft office products and project management tools.

• Effective oral and written communications skills necessary.

• Must have a general understanding the business environment and associated systems.

• Must be detail oriented and have a general understanding of corporate business systems.

• Must be able to work independently with assigned task.

• Ability to investigate, perform preliminary testing and present findings.

• Technical writing skills needed.

• Must have related enrollment experience in the Health Rules system platform, a full understanding of the Front Office System and how these platforms interact with EDI Portal for EDI enrollment validation.

Education & Experience

• Bachelor's degree in Business Administration, Management Information Systems, Computer Science or equivalent work experience in the Healthcare/Technology space

• Understanding of XML/ANSI 834 / HIPAA X12 transactions would be beneficial.

• In lieu of degree, minimum 2- 3 years proven EDI/eligibility experience

• Strong communication and analytical skills required.

Scope:

• Has working knowledge and experience in own discipline.

• Continues to build knowledge of the organization, processes and customers.

• Performs a range of mainly straightforward assignments.

• Uses prescribed guidelines or policies to analyze and resolve problems.

• Receives a moderate level of guidance and direction from more senior level roles.