• EDI Enrollment Specialist

    Job Locations US-CA-Fairfield
    Job ID
    2018-1357
    Category
    Information Technology
  • Overview

    The primary function of this position is to request and/or accept EDI agreements from Trading Partners who want to enroll into PHC’s EDI Trading Network; request and receive test files; and ensure they are HIPAA compliant, verified for date validations, and approved for production submissions and/or receipts. The secondary function of this job is to act as a backup for the EDI Production Support Analyst and perform all of his/her duties. The daily activities will include transferring data through secure channels; testing and loading data in the test and production environments; negotiating with Trading Partners for EDI agreements; introducing EDI Technologies to providers; and enhancing PHC’s objectives of electronic data exchanges.

    Responsibilities

    • Work with providers, providers’ software companies, 3rd party vendors, and clearing houses to facilitate submissions and/or receipts of HIPAA compliant ANSI X12 EDI transactions.
    • Provide assistance to providers and Trading Partners in preparing HIPAA compliant ANSI X12 EDI transactions for PHC.
    • Work with Trading Partners to request and/or accept EDI agreements and process them into PHC’s EDI systems.
    • Set-up mailboxes for Trading Partners on PHC’s sFTP server for secure data transfers.
    • Work with Trading Partners to request and receive test files, ensuring they are HIPAA compliant, verified for data validations, and approved for production submissions and/or receipts.
    • Act as a backup for the EDI Production Support Analyst and perform all of his/her duties.
    • Work with EDI programming staff to make sure all the necessary programs, processes, and scripts are in place for processing EDI data in and out of PHC’s systems.
    • Work with EDI programming staff related to data formatting/mapping electronic data exchanges.
    • Coordinate electronic data transmission and exchanges between PHC and the Trading Partners.
    • Work with Claims and Provider Relations staff for integration of newly-converted electronic providers.
    • Maintain knowledge on HIPAA compliant ANSI X12 EDI transactions such as the 837, 277CA, 835, 834, etc. and the related TR3 specifications.
    • Maintain Payer agreements, Companion documents, and policy and procedure documents related to EDI transactions.

    SECONDARY DUTIES AND RESPONSIBILITIES

    • Participate in special projects and assignments as needed.

    Qualifications

    Education and Experience

    Bachelor’s degree in Computer Science, Information Systems, Business, or a related field; or equivalent combination of education and experience. Minimum one (1) year of EDI involvement in a claims/billing environment. Excellent written and verbal communication skills. Experience with customer service is a plus.

     

    Special Skills, Licenses and Certifications

    Understanding of HMO claims/billing processes; effective communication skills with staff and outside sources; ability to research and work with outside providers in a multitude of complex environments. Basic SQL commands for electronic table maintenance.

     

    Performance Based Competencies

    Good oral and written communication skills; excellent customer service skills with ability to assess and resolve problems and issues in an efficient and effective manner; strong Project Management skills.

     

    Work Environment And Physical Demands

    Ability to use a computer keyboard. 40-50% of work time is spent in front of a computer monitor. Frequent telephone use.

     

     

     

    All HealthPlan employees are expected to:

     

    • Provide the highest possible level of service to clients;
    • Promote teamwork and cooperative effort among employees;
    • Maintain safe practices; and
    • Abide by the HealthPlan’s policies and procedures, as they may from time to time be updated.

     

    IMPORTANT DISCLAIMER NOTICE

     

    The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.

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