EDI Claims Specialist - Rewarding Work

The 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.