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.
SECONDARY DUTIES AND RESPONSIBILITIES
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:
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.