Senior EDI Claims Specialist

https://www.vivahealth.com/careers/benefits

Job Description

The Senior EDI (Electronic Data Interchange) Claims Specialist will provide analysis and support to the EDI Claims Coordinator in processing inbound and outbound EDI claim transactions. This individual will evaluate the reply files from vendors, report errors, correct the data, and resubmit claims as necessary. This position will document required changes, assist in testing new transactions sets, and respond to internal and external EDI-related issues.

Key Responsibilities

• Provide analysis and support on complex EDI Claim Issues.

• Create and submit EDI claim transactions to various vendors and Business Partners.

• Document and evaluate reply files from Business Partners, correct the data, and resubmit files.

• Test and document new EDI processes as directed.

• Assist the EDI claims coordinator with implementing new claims related EDI transactions.

REQUIRED QUALIFICATIONS:

• Bachelor's degree or equivalent experience

• 5 years' experience with auditing / analyzing claims or medical data

• 3 years' experience working with data integration

• Demonstrated aptitude for using relational databases

• Proficiency with Excel / importing data into Excel tables

• Ability to present ideas and solutions in a user-friendly language

• Self-motivated, organized, and detail oriented

• Analytical and problem solving skills with the ability to prioritize and execute tasks

PREFERRED QUALIFICATIONS:

• Experience with ANSI ASC X12 transaction sets (835, 837, 217, 272, 277, etc.)

• Experience with PowerSTEPP or similar software

• Experience with payor-side healthcare

• Experience with Extol Integration Software

• Knowledge of PowerSTEPP claims and eligibility systems

• Familiarity with Ingenix Claredi

• Familiarity with FTP software

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