EDI Specialist

W2 Only, no sponsorship available

Exciting opportunity for an EDI Specialist for a Contract to hire position in Philadelphia, PA. In this role you will work 3 days / week in the Philadelphia, PA office.

Job Description

• Initially focused on overseeing spreadsheet process (still working with EDI but focused on a subset of files coming in).
• They will be cross trained to take on more EDI / other 834 files work.

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 Responsibilities :

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.

Education & Experience :

• 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.
1 day ago