EDI Coordinator

We're excited about the potential people bring to our organization. You can grow your career here while enjoying first-class perks, benefits and a culture that fosters growth, innovation and collaboration.

The Electronic Data Interchange (EDI) Coordinator will provide support to the implementation and/or file import functions within the Core Systems team. The file import process for eligibility and EDI imports will include verification of master data elements and entry of additions and corrections. They will troubleshoot and monitor the production of EDI files to include eligibility, claims and prior authorization ensuring that the files are received, processed, and reviewed for errors. The implementation and ongoing maintenance of Standard HIPPA Formats includes but is not limited to 837 (claims), 835 (remittances), 834 (eligibility), 270/271 (eligibility inquiry and response), 276/277 (claims status inquiry and response) and 278 (referral/prior authorization) EDI transactions.

Along with the EDI Specialist, the Coordinator will work collaboratively with business office staff, third party payers and clearinghouses to process and maintain these transactions in an integrated, efficient, and cost-effective manner. The Coordinator will utilize their knowledge to aid the department on projects, file imports and implementations, lending support, recommendations and guidance when needed on the Core System Support and Tech Services Teams for EDI related tasks.

• High School Diploma or GED required; Associate's degree preferred.

• Three (3) years of experience in EDI, e-Commerce, OR healthcare transactions (enrollment, claims, reimbursement, data entry) required.

• Experience with ANSI X12 and HIPAA standard formats related to eligibility, claims and remittances preferred.

• Strong technical knowledge and familiarity with EDI and communication technologies and tools.

• Demonstrated analytical and problem-solving skills.

• Ability to clearly translate technical and/or complex concepts into lay terms.

• Strong verbal and written communications skills with the ability to interact effectively with internal IT customers and resources, external trading partners, and upper management.

• Proven examples of displaying Nova's Core 4: Act with Passion, Work Together, Be Accountable, Build Trust.

• Assist with the implementation and development of third-party Electronic Data Interchange (EDI) solutions.

• Serve as contact for internal and external customers, trading partners and vendors.

• Develop and document EDI mapping specifications.

• Work with the business to translate business requirements into functional specifications and work with our Information Technology Group and appropriate technology vendors to ensure these requirements are translated into technical requirements.

• Responsible for understanding the CMS legislation to ensure that Nova is in compliance with the EDI regulations.

• Maintain EDI Training Manual and EDI Companion Guide.

• Compare compatibility of EDI related products to company systems and make recommendations.

• Create test plans; conduct and manage quality assurance and user acceptance testing.

• Coordinate production support for on-going EDI processing.

• Troubleshoot failed transmission and communicate results to internal customers and trading partners.

• Coordinate meetings as needed with EDI Partners to review current EDI transactions and issues.

• Research, prepare and provide training on future EDI industry changes that may affect Nova.

• Provide documentation and follow-up on problem issues. Provide documentation for software changes and new software.

• Use automated file upload processes to reduce data entry time and errors. Prepare files and process file updates to the system.

• Provide low complexity analytics to promote data quality and integrity. When information is incomplete or inconsistent, review with appropriate department or vendor to obtain necessary remediation.

• Investigate issues reported. Identify root cause and resolve utilizing relevant best practices for solution.

• Ensure data integrity.

• Proactively monitor and analyze data files for continuous improvements on the cleanliness of data. Develop processes to recognize and analyze suspicious data.

• Create and maintain documentation as dictated by type of file: configuration profiles, responsible departments, and others as required.

• Document and analyze current business processes related to EDI and make recommendations to the director for process improvements to create cost effective solution(s).

• Analyze and report on key metrics.

• Create test plans; conduct and manage quality assurance and user acceptance testing.

• Facilitate meetings as needed with EDI Partners to review current EDI transactions and issues.

• Focus on continued learning - acquire extensive knowledge of master data field functionality.

Immigration or work visa sponsorship will not be provided for this position

Hiring Compensation Range: $27.50 - $32.50 hourly

Compensation may vary based on factors including but not limited to skills, education, location and experience.

In addition to base compensation, associates may be eligible for a scorecard incentive, full range of benefits and generous paid time off. The base salary range is subject to change and may be modified in the future.

As an Equal Opportunity / Affirmative Action Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant's race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship and immigration status, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law. Click here for additional EEO/AAP or Reasonable Accommodation information.

Current Associates must apply internally via the Job Hub app.