Senior EDI Coordinator

This is a fully remote position, open to applicants in Massachusetts.

📋 Description

• Supervise the organization's EDI processes.

• Monitor the flow of incoming and outgoing EDI files.

• Investigate and analyze unsuccessful transmissions.

• Identify recurring issues and engage the relevant parties for resolution.

• Address provider inquiries related to submission discrepancies.

• Drive initiatives to enhance the number of contracted providers utilizing electronic submission.

• Train and mentor EDI staff and other departmental members as necessary.

• Create documentation for new EDI procedures, policies, and workflows.

• Serve as a liaison between IT, Configuration, EDI Coordinators, internal departments, external clients, and contracted providers.

• Execute HIPAA transaction sets throughout the organization, including 270/271, 276/277, 278, 820, 835, 837I, and 837P.

• Represent the EDI team in meetings with both internal and external customers.

• Establish security measures for online tools, such as Provider Tools and Employer Tools.

• Operate KEA scripting software for Weight Watchers claims.

• Provide weekly updates regarding Trading Partners in the testing phases.

• Test Edifecs and QNXT upgrades or modifications related to electronic submissions.

• Evaluate new and updated technology applications against existing EDI logic and share results.

• Enhance the rate of provider electronic claim submissions and EDI performance metrics.

• Improve the auto-adjudication rate of EDI claims.

• Manage communications regarding submission issues that need troubleshooting.

• Cultivate relationships with clearinghouse vendors.

• Track EDI file names, dates, claim counts, fatal edits, and processing statuses.

• Pursue quality improvements for the EDI process.

• Supervise and manage the reconciliation of EDI claim submissions.

• Work autonomously with minimal supervision while adhering to deadlines.

⛳️ Requirements

• Bachelor’s Degree is mandatory.

• A Master’s degree or foreign equivalent in Electrical/Electronic Engineering, Electrical Power Systems, Computer Science, Engineering, or a related discipline is preferred.

• A minimum of two (2) years of experience as a Software Engineer or in a related field is preferred for candidates with the desired Master’s degree.

• If the major is different from the preferred, 4–7 years of experience in the operational aspects of a Managed Care Organization, or 2+ years of experience with the preferred degree is required.

• QNXT experience is essential.

• High proficiency in PC operations is a must.

• Strong knowledge of MS Office is required.

• Experience with the internet is necessary.

• BizTalk experience is a requirement.

• Excellent project leadership abilities are essential.

• Demonstrated verbal and written communication skills are required.

• EDI experience is necessary, including regression testing and SNIP level validation.

• Basic SQL skills are required for troubleshooting and issue validation.

🏝️ Benefits

• Equal employment opportunity and anti-discrimination protections.

• Potential for remote work arrangements (as indicated in the job title).