EDI Manager
4 weeks ago
- Develop and Support a paperless (electronic) system for conducting business
- Manage inbound data feeds including: all claim file types, MOR, MMR, DXHCC, RAPS, Reconciliation files, eligibility and capitation data
- Manage outbound encounter data submission and process, Alternate Submission Methods (ASM), and supplemental "Clinical data submissions to health plan trading partners or designated clearinghouses.
- Responsible for full reconciliation of encounter data between clients, Health plans and CMS
- Responsible for analysis of Care gap reports and to identify data gaps.
- Support the centralization of information for using OnBase for content management
- Support claims in load processes and procedures
- Lead all Encounter and EDI related projects
- Attend various meeting including: Operations, project specific, JOCs / encounter performance and adhoc.
- Communicate business needs, requirements and enhancement ideas
- Report issues and failures.
- Confirm audit and/or exception reports are run at appropriate frequencies and identified items and exceptions are resolved satisfactorily and within expected timeframes.
- Work with team to enhance operations, comply with new regulations, resolve failures and document policies and procedures
- Bachelor's Degree (four-year college or technical school) Required, Field of Study: Computer Science, Information Systems or equivalent experience
- 3+ years of experience in Software Development.
- Thorough knowledge of programming languages including VB, C#, SQL, PowerShell
- 3+ years of SQL Server ETL Development experience using SSIS
- 3+ years of experience with Microsoft SQL Reporting Services (SSRS)
- Proficient in using Team Foundation Server for source control
- Experience with SQL Server 2012
- Experience with Transactional Systems, specifically X12 Claims, Eligibility and Authorization transactions.
- EZCAP and EZEDI experience preferred.
- Experience with encounter data submission preferred
- Project management skills in the context of software development preferred
- Previous experience in the healthcare or finance industry preferred
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EDI Manager
3 weeks ago
Long Beach, United States EDI Staffing Full timeDevelop and Support a paperless (electronic) system for conducting business Manage inbound data feeds including: all claim file types, MOR, MMR, DXHCC, RAPS, Reconciliation files, eligibility and capitation data Manage outbound encounter data submission and process, Alternate Submission Methods (ASM), and supplemental "Clinical data submissions to health...
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EDI Manager
2 weeks ago
Long Beach, United States EDI Staffing Full timeDevelop and Support a paperless (electronic) system for conducting business Manage inbound data feeds including: all claim file types, MOR, MMR, DXHCC, RAPS, Reconciliation files, eligibility and capitation data Manage outbound encounter data submission and process, Alternate Submission Methods (ASM), and supplemental "Clinical data submissions to...
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EDI Manager
2 weeks ago
Long Beach, United States EDI Staffing Full timeDevelop and Support a paperless (electronic) system for conducting business Manage inbound data feeds including: all claim file types, MOR, MMR, DXHCC, RAPS, Reconciliation files, eligibility and capitation data Manage outbound encounter data submission and process, Alternate Submission Methods (ASM), and supplemental "Clinical" data submissions to...
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EDI Manager
2 weeks ago
Long Beach, United States EDI Staffing Full timeDevelop and Support a paperless (electronic) system for conducting business Manage inbound data feeds including: all claim file types, MOR, MMR, DXHCC, RAPS, Reconciliation files, eligibility and capitation data Manage outbound encounter data submission and process, Alternate Submission Methods (ASM), and supplemental "Clinical data submissions to...
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EDI Manager
2 weeks ago
Long Beach, United States EDI Staffing Full timeDevelop and Support a paperless (electronic) system for conducting business Manage inbound data feeds including: all claim file types, MOR, MMR, DXHCC, RAPS, Reconciliation files, eligibility and capitation data Manage outbound encounter data submission and process, Alternate Submission Methods (ASM), and supplemental "Clinical" data submissions to...
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EDI Manager
4 weeks ago
Long Beach, United States EDI Staffing Full timeDevelop and Support a paperless (electronic) system for conducting business Manage inbound data feeds including: all claim file types, MOR, MMR, DXHCC, RAPS, Reconciliation files, eligibility and capitation data Manage outbound encounter data submission and process, Alternate Submission Methods (ASM), and supplemental "Clinical data submissions to health...
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EDI Manager
4 weeks ago
Long Beach, United States EDI Staffing Full timeDevelop and Support a paperless (electronic) system for conducting business Manage inbound data feeds including: all claim file types, MOR, MMR, DXHCC, RAPS, Reconciliation files, eligibility and capitation data Manage outbound encounter data submission and process, Alternate Submission Methods (ASM), and supplemental "Clinical data...
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EDI Manager
1 month ago
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EDI Manager
2 weeks ago
Long Beach, United States EDI Staffing Full timeDevelop and Support a paperless (electronic) system for conducting business Manage inbound data feeds including: all claim file types, MOR, MMR, DXHCC, RAPS, Reconciliation files, eligibility and capitation data Manage outbound encounter data submission and process, Alternate Submission Methods (ASM), and supplemental "Clinical data...
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EDI Manager
1 week ago
Long Beach, United States EDI Staffing Full timeDevelop and Support a paperless (electronic) system for conducting business Manage inbound data feeds including: all claim file types, MOR, MMR, DXHCC, RAPS, Reconciliation files, eligibility and capitation data Manage outbound encounter data submission and process, Alternate Submission Methods (ASM), and supplemental "Clinical data submissions to health...
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EDI Coordinator
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EDI Coordinator
2 months ago
Huntington Beach, United States TYR Sport Full timeSummary /Objective As an Electronic Data Interchange (EDI) Coordinator, you will be responsible for managing the implementation, maintenance, and optimization of EDI processes and systems. This role involves collaborating with internal teams, external partners, and vendors to ensure seamless electronic data exchange and compliance with EDI standards. ...
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EDI Coordinator
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Huntington Beach, United States TYR Sport, Inc. Full timeSummary /ObjectiveAs an Electronic Data Interchange (EDI) Coordinator, you will be responsible for managing the implementation, maintenance, and optimization of EDI processes and systems. This role involves collaborating with internal teams, external partners, and vendors to ensure seamless electronic data exchange and compliance with EDI standards.Position...
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EDI Coordinator
2 months ago
Huntington Beach, United States TYR Sport, Inc. Full timeSummary /ObjectiveAs an Electronic Data Interchange (EDI) Coordinator, you will be responsible for managing the implementation, maintenance, and optimization of EDI processes and systems. This role involves collaborating with internal teams, external partners, and vendors to ensure seamless electronic data exchange and compliance with EDI standards.Position...
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Sr Business Analyst
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