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    EDI Claims Specialist - Los Angeles, United States - MedPOINT Management

    MedPOINT Management
    MedPOINT Management Los Angeles, United States

    3 weeks ago

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    Description

    Job Description

    Job Description

    The EDI Claims Specialist is responsible for retrieving, processing, validating, and posting electronic claim data files into MPM's core system, EZ-CAP.

    Reporting to the Supervisor, EDI Claims, the EDI Claims Specialist will ensure all files are processed timely and meet compliance regulations.

    Duties and Responsibilities

    • Download 837 EDI claim files from clearinghouses, health plans, and 3 rd party vendors on a daily basis.
    • Develop an understanding of electronic data file(s) definitions, HIPAA standard ANSI 837 formats, and other Health Plan proprietary format(s) for claim data files.
    • Use Bowman to clean up / process / and create EPF data files to load into EZ-NET.
    • Document, track, and reconcile all assigned or re-assigned files processed from beginning to end.
    • Fix rejects/post errors to ensure 100% of claim records in each batch are documented and posted.
    • Ability to research and resolve issues, escalating when necessary to team leadership.
    • Track all issues encountered with files and/or team processes and/or data daily in Smartsheet.
    • Conduct daily reconciliation of file assignments to ensure 100% of assigned files are completed.
    • Assist with onboarding of new EDI Claims team members as assigned.
    • Assist with creating and/or updating team job aids, standard operating procedures (SOPs), and workflows.
    • Answer client phone calls and respond to client emails.
    • Attend organizational meetings as required.
    • Other duties as assigned by team leadership. Minimum Job Requirements
    • High School diploma or GED equivalent or 1-year of equivalent experience in a similar role and/or extensive experience with managed healthcare eligibility data and requirements.
    • Experience working with EZ-CAP preferred.
    • Working knowledge of MS Office suite of products (Word, Excel, Outlook, PowerPoint).
    • Understanding of managed healthcare business operations preferred. Skill and Abilities
    • Strong organizational, analytical, and oral/written communication skills.
    • Strong commitment to detail with ability to work with little supervision.
    • Excellent critical thinking skills and possesses the ability to identify patterns and deviations from normal processes.
    • Eagerness to contribute to team-oriented environment.
    • Ability to multi-task in a fast-paced environment.
    • Excellent customer service and documentation skills.
    • Familiarity with 837 HIPAA file format, EZ-CAP and EZ-NET, Clearinghouses and Smartsheet knowledge is a plus.
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