POSITION SUMMARY
The EDI Specialist role is responsible for the retrieval and submission of inbound and outbound data. Including daily auditing and reconciliation of data on a department level, to include internal staff and external vendors. The Specialist is also responsible for training staff on all new or updated procedures.
ESSENTIAL FUNCTIONS
- Receive and submit files to and from various vendors daily.
- Process 837 files resulting in conversions of .txt files.
- Prep and transfer files to be loaded into internal programming system for processing and payment.
- Encrypt and decrypt files.
- Run queries in Access.
- Run and review reporting in Excel.
- Conduct eligibility matching based on enrollee and members demographics within the internal master database.
- Accurately routing completed claims to various internal mailboxes, attention to detail and emphasis on accuracy and meeting timelines successfully.
- Train EDI Coordinators on various workflow to include new or updated procedures.
- Interprets and explain procedures to EDI Coordinators.
- Handle internal audits for the department to include internal staff and external vendors.
- Handle ongoing projects within the department when necessary, while maintaining the current workflows assigned.
- Handle complex issues within the department, when additional assistance is needed from other departments, staff, or outside vendors.
- Provide EDI support for outside trading partners and internal staff.
- Processing of failed transactions and resolve missing acknowledgments.
- Performs other related duties as assigned
EDUCATION
- High School Diploma or equivalent required.
EXPERIENCE AND SKILLS
- Data Entry 6,000 keystrokes per hour with accuracy.
- Intermediate knowledge of Word, Excel, and Access.
- Good problem-solving skills.
- Analytical skills
- Highly motivated and the ability to work well independently and within a team environment.
- Attention to detail and accuracy.
POSITION COMPETENCIES
- Communication
- Customer Focus
- Accountability
- Functional/Technical Job Skills
PHYSICAL DEMANDS
- This is a standard desk role – long periods of sitting and working on a computer are required.
WORK ENVIRONMENT
- Remote
Here at Allied, we believe that great talent can thrive from anywhere. Our remote friendly culture offers flexibility and the comfort of working from home, while also ensuring you are set up for success. To support a smooth and efficient remote work experience, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 100Mbps download/25Mbps upload. Reliable internet service is essential for staying connected and productive.
The company has reviewed this job description to ensure that essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills, and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.
Compensation is not limited to base salary. Allied values our Total Rewards, and offers a competitive Benefit Package including, but not limited to, Medical, Dental, Vision, Life and Disability Insurance, Generous Paid Time Off, Tuition Reimbursement, EAP, and a Technology Stipend.
Allied reserves the right to amend, change, alter, and revise, pay ranges and benefits offerings at any time. All applicants acknowledge that by applying to the position you understand that the specific pay range is contingent upon meeting the qualification and requirements of the role, and for the successful completion of the interview selection and process. It is at the Company's discretion to determine what pay is provided to a candidate within the range associated with the role.
Skills Required
- High School Diploma or equivalent
- Experience processing EDI 837 files and handling .txt conversions
- Proficiency with Microsoft Access (run queries)
- Intermediate Microsoft Excel skills (reporting)
- Intermediate Microsoft Word skills
- Ability to encrypt and decrypt files
- High-volume data entry (6,000 keystrokes per hour) with accuracy
- Attention to detail, analytical and problem-solving skills
- Ability to train staff and explain procedures
- Ability to work independently and within a team
What We Do
Allied is a national healthcare solutions company that works with organizations who choose to take control of their healthcare. We customize employer self-insurance benefits to align with individual choice and organizational need while integrating medical management innovations and cost-control strategies. With healthcare designed for people, employers never have to choose between price and the best-fit insurance products to protect employees and their families. Allied’s philosophy is to create a culture of health for our member organizations and their employees beyond simple, medical health. We integrate administrative services, care solutions and analytics to achieve better clinical, behavioral and social patient outcomes. Allied’s programs and benefit services are designed and structured to infuse value on every front – for employers and HR departments, for plan members and their families, for healthcare providers, and for us. We’re in this together, committed to your future.
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