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Job DescriptionThe EDI Claims Specialist is responsible for retrieving, processing, validating, and posting electronic claim data files into MPM’s core system, EZ-CAP®. Reporting to the Supervisor, EDI Claims, the EDI Claims Specialist will ensure all files are processed timely and meet compliance regulations. Duties and Responsibilities Download 837 EDI claim files from clearinghouses, health plans, and 3 rd party vendors on a daily basis. Develop an understanding of electronic data file(s) definitions, HIPAA standard ANSI 837 formats, and other Health Plan proprietary format(s) for claim data files. Use Bowman to clean up / process / and create EPF data files to load into EZ-NET®. Document, track, and reconcile all assigned or re-assigned files processed from beginning to end. Fix rejects/post errors to ensure 100% of claim records in each batch are documented and posted. Ability to research and resolve issues, escalating when necessary to team leadership. Track all issues encountered with files and/or team processes and/or data daily in Smartsheet. Conduct daily reconciliation of file assignments to ensure 100% of assigned files are completed. Assist with onboarding of new EDI Claims team members as assigned. Assist with creating and/or updating team job aids, standard operating procedures (SOPs), and workflows. Answer client phone calls and respond to client emails. Attend organizational meetings as required. Other duties as assigned by team leadership. Minimum Job Requirements High School diploma or GED equivalent or 1-year of equivalent experience in a similar role and/or extensive experience with managed healthcare eligibility data and requirements. Experience working with EZ-CAP® preferred. Working knowledge of MS Office suite of products (Word, Excel, Outlook, PowerPoint). Understanding of managed healthcare business operations preferred. Skill and Abilities Strong organizational, analytical, and oral/written communication skills. Strong commitment to detail with ability to work with little supervision. Excellent critical thinking skills and possesses the ability to identify patterns and deviations from normal processes. Eagerness to contribute to team-oriented environment. Ability to multi-task in a fast-paced environment. Excellent customer service and documentation skills. Familiarity with 837 HIPAA file format, EZ-CAP® and EZ-NET®, Clearinghouses and Smartsheet knowledge is a plus.
Seniority level
Entry level
Employment type
Full-time
Job function
Information Technology
Industries
Medical Practices
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