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Sr. EDI Claims Specialist
4 months ago
The Senior EDI Claims Specialist is responsible for overseeing the retrieval, processing, validation, and posting of electronic claim data files into MPM’s core system, EZ-CAP®. Serving as a subject matter expert, the Senior EDI Claims Specialist will support the EDI Claims Team through training, monitoring of workflows, completion of daily tasks, and reconciliation reporting. Reporting to the EDI Claims Leadership, the Senior EDI Claims Specialist will ensure all files are processed timely and meet compliance regulations. Duties and Responsibilities • Monitor 837 EDI claim file downloads and processing to support team’s compliance. • Configure Bowman to clean up / process / and create EPF data files to load into EZ-NET®. • Coordinate and drive EDI Claims projects forward, as identified and prioritized by leadership. • Actively participate in clearinghouse, product vendor, and internal stakeholder meetings; taking meeting minutes and tracking follow up items. • Support team EDI claims reconciliation tracking accuracy through monitoring, validation, and escalations to Leadership when deficiencies are identified. • Address EDI teammate issues and barriers before escalation to team Supervisor. • Assist with onboarding new EDI Claims teammates and re-training of existing teammates on department processes and workflows. • Assist with creating and/or updating team policies, standard operating procedures, and job aids. • Other duties as assigned by leadership. Minimum Job Requirements • High School Diploma (bachelor degree preferred or 5+ years equivalent work experience in similar role). • Experience working with EZ-CAP® and EZ-NET®. • Working knowledge of MS Office suite of products (Word, Excel, Outlook, PowerPoint, and Visio). • Demonstrated analytical and organizational skills, experience working under deadlines, and strong understanding of project management. • Understanding of managed healthcare business operations. Skill and Abilities • Demonstrated understanding of electronic data file(s) definitions, HIPAA standard ANSI 837 formats, and other Health Plan proprietary format(s) for claim data files. • Knowledge of EDI Clearinghouses. • Strong commitment to detail with ability to work with little supervision. • Excellent critical thinking skills and possesses ability to identify patterns and deviations from normal processes. • Ability to multi-task in a fast-paced environment. • Strong follow through. • Eagerness to contribute to team-oriented environment. • Excellent customer service and documentation skills
