Edi Specialist
1 month ago
**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.
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