EDI Specialist » EltasJobs

The electronic data interchange (EDI) specialist’s main objective is to develop, coordinate, implement, and manage all EDI-related developments for our organization.

Responsibilities of the EDI Specialist position encompass the administration of all forms of data transfer processes between the company and vendors. The candidate will analyze, recommend, design, and implement software solutions that will streamline these processes.

This position will initially be on a contract basis, but may transition to a full-time position based on project requirements and skill level.

Essential Functions:

Design and develop an EDI solution producing appropriate documentation and with high degree of flexibility.
Perform systems and data analysis, including analyzing existing system/program logic difficulties, and revising the logic procedures involved as necessary.
Review test plan and test results to ensure solutions are thoroughly tested at all stages of development, and assist in preparation for production deployment.
Act as a liaison between internal and external customers, researching and providing answers to data questions.
Maintain best practices of network security and data protection.
Other duties as assigned.

Position Requirements:

5 + years of IT experience or combination of experience and education
3 + years of experience with various EDI technologies
2 + years of experience with Microsoft SQL Server and ASP.NET C#
Prior experience as a Member/Lead of IT projects of medium complexity working together with IT team to deliver results
Prior experience leveraging integration-related technologies in a transaction intensive environment
Experience working with transportation industry specific EDI technologies a plus

Knowledge, Skills and Abilities:

Ability to work independently as well as part of a team
Ability to solve problems and articulate potential solutions
Ability to effectively communicate IT terminology to someone that does not understand technical terms
Strong professional, interpersonal and organizational skills
Demonstrated cross-functional team collaboration skills in a rapidly changing, high intensity, mission-oriented work environment
Flexibility to switch between projects as needed

Job Type: Contract

Required experience:

IT: 5 years
EDI technology: 3 years
SQL: 2 years

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Expanding access to affordable, high quality health care starts here. This is where some of the most innovative ideas in health care are created every day. This is where bold people with big ideas are writing the next chapter in health care. This is the place to do your life’s best work.(sm)

The EDI Specialist is responsible for facilitating all activities between the provider, clearinghouse and IT in order to establish connectivity for submitting claim files. They will work closely with Network Management, Contracting and Claims to ensure all appropriate data elements are transmitted for claims payment. They will also be responsible for creation and maintenance of associated companion guides and mapping business rules as well as monitoring throughput on all submitters and converting paper submitters to EDI.

Primary Responsibilities:
Act as a liaison between the provider and IT to set-up providers submitting new claim files

Coordinate set-up activities with selected clearinghouse to ensure proper steps are followed for an effective transition

Validate post-implementation submissions to ensure file integrity and established business rules are applied

Perform an outreach process to determine proper EDI submission method and customize based upon provider’s business needs

Identify providers who submit paper claims to target for EDI implementation

Publish monthly reports to illustrate EDI submission rates and related metrics

Investigate identified claims in-load discrepancies and work with related billers or vendors to remediate issue

Required Qualifications:
High school diploma or equivalent

2+ years’ experience with health care and/or managed care claims

2+ years’ prior experience working with EDI transactions

Intermediate proficiency with MS Office, specifically Word, Excel and Outlook

Preferred Qualifications:
Excellent interpersonal skills at both an individual and team level

Excellent written and verbal communication skills

What’s the first thing that happens when one of the most successful physician groups in Orange County comes together with a global leader in health care? Opportunity. With Monarch HealthCare joining Optum and the UnitedHealth Group family of companies, people like you will find increasing levels of challenge, impact and professional success. With a vibrant network of hospitals and urgent care centers, we’re changing health care for the better by improving access to affordable, high quality care, and working together to improve the patient experience. That takes passion, commitment, intense focus and the ability to contribute effectively in a highly collaborative team environment. Are you with us? Learn more about this exciting opportunity to do your life’s best work.(sm)

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

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