Claims Management Analyst III, HealthPlan EDI Experience Required
CareSource
full-time
Posted on:
Location Type: Remote
Location: Remote • 🇺🇸 United States
Visit company websiteSalary
💰 $70,800 - $113,200 per year
Job Level
Mid-LevelSenior
About the role
- Manage the EDI (Electronic Data Interchange) trading partners and network of clearinghouses to ensure accurate and timely exchange of information
- Work closely with Vendor Management to improve and maintain trading partner agreements
- Provide Subject Matter Expertise (SME) to all departments regarding eBusiness specific EDI transactions
- Build, sustain and leverage relationships to allow for continuous improvement of the EDI business process
- Responsible for eBusiness EDI requirements that support regulatory, compliance, and business needs
- Provide critical reporting and analysis of functional performance
- Review and analyze the effectiveness and efficiency of existing processes and systems
Requirements
- Bachelor’s degree or equivalent years of relevant work experience is required
- Minimum of five (5) years of health care operations experience in insurance, managed care, or related industry is required
- Advanced knowledge of healthcare EDI files (837, 277CA, 999, 270/271, 276/277, etc.)
- Advanced computer skills
- Data analysis and trending skills to include query writing
- Working knowledge of managed care and health claims processing
- Must be able to effectively interact with all levels of management within the organization and across multiple organizational layers
Benefits
- Health insurance
- 401(k) matching
- Flexible working hours
- Paid time off
- Substantial and comprehensive total rewards package
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
EDIhealthcare EDI filesdata analysisquery writinghealth claims processing
Soft skills
relationship buildingcommunicationinterpersonal skillscritical thinking