Sr EDI Specialist- Central Florida - HealthFund Solutions

HealthFund Solutions Florida, United States

1 week ago

Description

**We do not sponsor visas**

**We do not work with staffing agencies**

At HealthFund Solutions, we are an advocate for uninsured patients and a partner to hospitals and healthcare providers.

With decades of experience in the healthcare field, we observed a rising need to help a percentage of the American population that continues to grow every day—those living without health insurance. Through sponsorship programs, Medicaid screening and premium monitoring, we empower patients to get the coverage and care they need and get back on their feet.

Reporting to the Vice President/Chief Technology Officer, the Senior EDI Specialist provides technical support during and after implementation of electronic data interchange applications used in HealthFund Solutions. You are also responsible for monitoring the processing and posting activities of EDI files submitted by contracted Trading Partners, correct identified errors, and reconcile data discrepancies, to ensure timely capture of insurance eligibility with Trading Partners. The Senior EDI Specialist is also responsible for providing timely acknowledgement to EDI submitters' requirements, communicating to submitters for data rejections and follow up with resubmission activities. You will work closely with other IT department staff with troubleshooting and other HealthFund Solutions Operations staff.

Responsibilities:

· HealthFund Solutions processes electronic claims and eligibility files and ingests files into our data warehouses in Azure

· Works with internal IT staff on setup, testing and implementation of new Clearinghouses and trading partners

· Document and process flow HFS trading partner connections and data flow to and from trading partners

· Communicates with internal HealthFund Solutions staff and clearinghouse vendors regarding day-to-day EDI transactions

· Monitors, reports, and tracks error trends to manage resolution initiatives for SFTP, x12 and REST API connections

· Works under the direction of the Director of Information Technology on testing and implementation of new files and-or file changes

· Assists with the testing of new releases on updates to HealthFund Solutions ADF and trouble shoots problems prior to loading clearinghouse responses into production SQL databases

· Assists with projects including group and vendor implementations and data projects dealing with EDI Transactions

· Analyze and understand implementation guidelines/specifications for both batch and real-time for all HIPAA X12, REST API Healthcare transactions

· Prepare, implement, and monitor any projects for onboarding new hospital entities/clearinghouse trade partners to determine readiness for conducting the 270/271,

276/277 and 278 transactions Serve as IT project subject matter expert and perform project scrum with other project team members

· Provide backup assistance with connectivity SFTP, SSL FTP, TLS, API, and HyperTerminal setup to ensure safe delivery and receipt of files

· Responsible to reconcile uploaded records with submitted records to ensure data accuracy and follow up with rejected records and/or files

· Responsible for planning, implementing, and managing HIPPA EDI projects relating to these transactions, including end-user contact, analysis, design, mapping, programming, training, and documentation

· Create the SOP's for working the clearinghouse rejections correctly

· Responsible for communicating with Trading Partners via email or phone for data errors and file rejects information and follow through with resubmission activities

· Catalog and maintain an EDI processing log for each individual Trading Partner that submits claims electronically

Requirements:

· Bachelor's degree in business or healthcare administration or related field OR five (5) to seven (7) years' experience in hospital and/or healthcare

· Understanding of 270/271, 834/835 and 837 EDI Requests and Responses

· Understanding and experience with EDI guide

· Experience with Clearinghouses and their respective technology

· Strong analytical, oral, written communication skills

· Familiarity with health insurance and EHR Systems

· Advanced knowledge in Microsoft Word, Excel, Access, Outlook, and the like

· *Remote/Hybrid – at any point, if required to work from home a minimum internet speed of 75Mbps and reliable cellular signal is required to be able to do this job effectively

Physical Abilities:

While performing the duties of this job

• Ability to sit for long periods of time entering data into the computer

• Ability to occasionally lift up to 10 pounds

• Ability to concentrate and stay on tasks for long periods of time

NOTE: This job description is not intended to be all-inclusive. Employee may perform other duties as required to meet the ongoing needs of the organization.

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