EDI Specialist
Specific Duties/Requirements
· Requires an extensive knowledge of EDI Portal and managing inbound EDI enrollment file activity.
· Responsible for ensuring successful transfer of inbound EDI enrollment data to include troubleshooting/reconciliation of data integrity issues.
· Responsible for managing EDI file activity for high-profile/complex EDI client business (BPO, Shared Services, non-standard, etc.).
· Direct contact between EDI senders, clients, Account Management teams, Customer Experience teams, BizTalk/.Net teams, and project teams.
· Responsible for supporting project work within the business area (lead and/or participate in project meetings, sprint work, business requirement documentation, system upgrades, and business check-outs).
· Responsible for managing all robotic process automation (RPA) work for the business area.
· Responsible for providing support to the Department’s Business Systems Analyst with client specific EDI enrollment testing.
Additional Job Responsiblities
· Assist in the development of user system documentation and desk level procedures.
· Manage daily team inventory activity and provide support/training/direction to Eligibility Specialist team members.
· Support enrollment related issues resolution/Enrollment Resolver Group participant.
· Organize/disperse team project work to other team members.
· Assist with manual enrollment processing for all lines of business.
· Support Member Enrollment System platform (to include development work, inquiries and EDI file activity)
· Meet departmental quality and production standards
· Other duties as assigned by the Leadership Team.
Knowledge Summary
· Ability to work with multiple business systems and have a general understanding of system design.
· Knowledgeable of Microsoft office products and project management tools.
· Effective oral and written communications skills necessary.
· Must have a general understanding the business environment and associated systems.
· Must be detail oriented and have a general understanding of corporate business systems.
· Must be able to work independently with assigned task.
· Ability to investigate, perform preliminary testing and present findings.
· Technical writing skills needed.
· Must have related enrollment experience in the Health Rules system platform, a full understanding of the Front Office System and how these platforms interact with EDI Portal for EDI enrollment validation.
· Bachelor's degree in Business Administration, Management Information Systems, Computer Science or equivalent work experience in the Healthcare/Technology space
· Understanding of XML/ANSI 834 / HIPAA X12 transactions would be beneficial.
· In lieu of degree, minimum 2- 3 years proven EDI/eligibility experience
· Strong communication and analytical skills required.
Scope:
· Has working knowledge and experience in own discipline.
· Continues to build knowledge of the organization, processes and customers.
· Performs a range of mainly straightforward assignments.
· Uses prescribed guidelines or policies to analyze and resolve problems.
· Receives a moderate level of guidance and direction from more senior level roles.
Diversity, Equity, and Inclusion
At AmeriHealth, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.
About Our Company
Serving more than 8 million people nationwide, including 2.5 million in southeastern Pennsylvania, Independence Health Group — together with its subsidiaries — is the leading health insurance organization in the Philadelphia region. Our mission to build healthier lives for you, your family, and your employees shapes our actions and decisions every day.
At AmeriHealth, we see each of our members as an individual, with unique needs and concerns. We’re dedicated to harnessing the very latest ideas and technologies to deliver access to care that meets those needs and surpasses your expectations. For more information about Independence access our website at www.ibx.com. We’re revolutionizing health care, and our focus is on you!
Equal Employment Opportunity
AmeriHealth is an Equal Opportunity and Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.
Agency Disclaimer
All resumes submitted directly to an AmeriHealth employee from a vendor via email, the Internet or in any other form without a valid written search agreement in place for this position from the Independence Blue Cross Family of Companies Human Resources Department will be deemed the sole property of AmeriHealth and the Independence Blue Cross Family of Companies. Please note that no fee will be paid in the event the candidate is hired by AmeriHealth or the Independence Blue Cross Family of Companies as a result of the referral or through means other than our established process.