EDI Specialist

4 weeks ago

Philadelphia, United States A2C Full time

W2 Only, no sponsorship available


Exciting opportunity for an EDI Specialist for a Contract to hire position in Philadelphia, PA. In this role you will work 3 days/week in the Philadelphia, PA office.


Job Description

  • Initially focused on overseeing spreadsheet process (still working with EDI but focused on a subset of files coming in).
  • They will be cross trained to take on more EDI / other 834 files work.


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 Responsibilities:

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.

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