Monitors daily EDI file function and error reporting; resolves file errors
Processes electronic claims and eligibility files and loads files into the claims processing system; Communicates with vendors and clients regarding day-to-day EDI transactions
Monitors error reports and resolves transaction errors for EDI processes
Monitors, reports, and tracks error trends to manage resolution initiatives
Works in partnership with IT on testing and implementation of new files and/or file changes, as needed
Provides support and researches solutions for user issues which cannot be resolved by the Service Desk
Receives calls forwarded from Service Desk, which cannot be resolved by Service Desk
Communicates with users to determine the problem
Identifies scope of problem and impact to other users
Analyzes problem and researches alternative solutions
Determines appropriate solution and makes necessary changes
Escalates problem to other IT staff if necessary
Reviews implementations, conducts testing and assists with new releases
Partners with IT to collaborate with trading partners to resolve any operational issues
Coordinates and tests all EDI implementations with new EDI partners
Analyzes current implementation in order to make recommendations for improvements
Assists with testing of new releases on the claims processing system and troubleshoots problems prior to loading into production
Assists with projects including group and vendor implementations and data projects.
Experience in Microsoft Outlook programs
Ability to learn relational database functions
Skill in critical thinking, problem analysis, and process documentation
Excellent documentation, verbal and written communication and interpersonal skills
Excellent analytical and problem-solving abilities
Ability to analyze detailed information
Ability to follow written instructions.
Knowledge and Skills:
Ability to meet deadlines.
Ability to maintain confidentiality of material and information.
Ability to work as a member of a team and with other departments.
Knowledge of Texas Medicaid and Chip.
High School Diploma or GED and 4 years Work experience in electronic data interchange (EDI) or health plan data and applications.
ELECTRONIC DATA INTERCHANGE