EDI Vendor Coordination Specialist in Cape Coral, FL at Johnson Service Group

Date Posted: 9/23/2021

Job Snapshot

Job Description

JobID: 385829

Johnson Service Group is hiring for a Vendor Coordinator (EDI/HIPAA) for our client in the Cape Coral area.

6-month Contract with possibility to extend

Manager Notes:
Looking for someone who has eligibility experience in Healthcare/insurance. Understand the Healthcare insurance lingo and file formats from 3rd party vendors

Track incoming/outgoing accumulator file receipts

Research & resolve rejected records

Review data on the incoming/outgoing files to ensure accurate information is being sent & received.
Assists with the development, coordination, implementation & management of incoming and outgoing claims accumulator file transmission, performing research as necessary.

Serve as point of contact and subject matter expert for research and remediation of claims accumulator issues working directly with other departments as well as clients & third-party administrators.

Duties & Responsibilities:

  • Perform upfront business analysis of benefit accumulator feeds from stakeholders’ clients, TPAs, and medical carriers
  • Manage end client & member expectations by ensuring timely, accurate upload of accumulator amounts
  • Proactively address file inefficiencies inaccuracies & errors
  • Update tracking tools on a daily basis
  • Actively participates in creating and implementing new interfaces by providing requirements
  • Provide guidance on reporting requirements
  • Act as the Business Owner for the Integrated Max Out of Pocket (TMOOP) processing
  • Analyze post edit reports and work toward resolution of discrepancies & errors
  • Assist with user acceptance testing (UAT) on system development requests
  • Interact with external vendors?
  • Participate in internal and external conference calls?
  • Other duties as assigned

Requirements:

  • 1 – 3 years of experience in related business systems analyst role required, preferably in a healthcare or health insurance environment
  • Relevant experience with member cost share, claims, benefits, and/or accumulators
  • Experience with eligibility processing preferred
  • Basic knowledge of standard EDI transactions and proprietary files
  • Basic knowledge of HIPAA and Regulatory Compliance
  • Detail oriented
  • Intermediate experience with MS Office applications, particularly MS Excel and MS Outlook
  • Excellent verbal and written communication
  • Proven ability to multi-task, prioritize and use analytical skills
  • Ability to work independently and as part of a team

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