Job Description

Job Title: EDI Data Manager

Location: Mason OH, 45040

Contract: 12-month contract, with potential extensions

Note: Hybrid 2-3 x a week office

GENERAL FUNCTION

The Membership Department is responsible for managing the business activities performed to enroll our client’s membership into our claims system. The department has a production team that manages the daily processing of membership enrollment requests and producing member id cards. The configuration team oversees the activities to setup the client enrollment process, testing of client enrollment data, and managing system enhancement initiatives to drive improvements into the technologies that support the production processes.

The main responsibilities for this position include managing daily production membership file exception errors, production reporting and audit process management. Additionally, this role supports the daily monitoring, analysis and approval of client eligibility files to ensure client Service Level Agreements (SLA) and department Key Performance Indicators (KPI) are met.

MAJOR DUTIES AND RESPONSIBILITIES

· Responsible for EDI file exception monitoring, research, client outreach, and exception resolution

· Responsible for overseeing, reviewing and updating SSAE 18 reports, and daily team production audit reporting.

· Responsible for producing month-end production reporting

· Manages department shared mailboxes to ensure timely resolution to all inquiries.

· Supports research and evidence collection for all SOC 1 audit requests

· Membership Data Subject Matter Expert (SME) daily file production and/or research.

· Performs electronic membership production file processing activities for timely member enrollment into systems – including supporting the coordination of file receipt, tracking, loading and reporting of membership data.

· Understands EDI eligibility file load process, client set-up parameters, and data submission layouts to effectively analyze file issues to determine resolution.

· Builds and fosters professional relationships with internal/external contacts to effectively communicate and expedite the resolution of file processing issues and to minimize member access to care issues.

· Able to multi-task and use multiple system applications to execute tasks relative to file production.

· Demonstrates ability to work well under pressure and in a high-volume environment

· Maintains understanding of all policies, standards of administration, service level agreements, procedures, protocols, compliance, and security guidelines.

BASIC QUALIFICATIONS

· Bachelor's Degree in a related field or equivalent work experience

· Lead the requirements gathering process for Medicaid-related EDI transactions (837)

· 5 years EDI experience, preferably in the medical insurance industry

· In-depth knowledge of EDI 837 transactions and state specific customizations.

· Experience in Data analysis, Business Objects, Visual Basic and/or SQL

· Ability to problem solve and troubleshoot electronic data issues

· Understands third party benefits and administration

· Critical thinking skills and the ability to interpret data results

· Ability to analyze and manipulate electronic data

· Strong written and oral communication skills

Best Regards,

Subhash V

Talent Acquisition Specialist

subhash@diversitynexus.net

732-782-5488

Job Type: Contract

Pay: $63.00 - $65.00 per hour

Expected hours: 25 per week

Schedule:

• Day shift

Work Location: Hybrid remote in 4000 , Mason, OH 45040

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