Job Description

Summary

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 3rd 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.

Skills and Abilities Required:

• 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. 

Salary Range:

• $24-$28 per hour, depending on experience 

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