Specialist I, EDI Claims

Summary

Duties and Responsibilities:

• 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.
• Develop an understanding of the EZ-CAP core system to navigate through claims and provider profiles.
• 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.
• 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 experience with managed healthcare eligibility data and requirements.
• Experience working with EZ-CAP/EZ-NET preferred.
• Experience working with Smartsheet preferred.
• Working knowledge of MS Office Suite of products (Word, Excel, Outlook, One Note)
• Understanding of managed healthcare business operations preferred.

Skills and Abilities:

• Effective organizational, analytical, and oral/written communication skills.
• Effective attention to detail.
• Eagerness to contribute to a team-oriented environment.
• Understanding and commitment to all the MPM Core Values.
• Commitment to fully understand and adhere to all policies and procedures.

Salary Range:

• $24 – $26 hourly