Description
BB28795
Oakland, CA 94612
7 + Months
EDI Coordinator
Coordinates and implements plans for all functional aspects of EDI (Electronic Data Interchange) for assigned business areas. Maintains trading partner agreements and service level agreements with all internal customers. In conjunction with clientIT technical staff, monitors EDI production activity, reports on progress/status to the Manager, Trading Partners and operating department management regularly.
Responsibilities:
- Coordinates and assists in the identification, implementation, and maintenance of EDI activities among assigned business areas. Establishes and supports communication with providers to share information, identifies opportunities and resolves problems related to EDI, prioritize customer requirements and maintains continuous improvement through customer feedback.
- Serves as the point of contact on status of EDI transactions activities for internal and external customers. Monitors the EDI programs, supplier performance and customer satisfaction to ensure timely and accurate results from EDI. Coordinates EDI processes which promote common EDI usage that are also user friendly for all business areas. Educates and trains staff of assigned business areas on EDI applications. Keeps abreast of EDI standards and trends. Develops and manages EDI documentation for internal and external use.
- Develops and generates routine and ad hoc reports and databases of significant size and complexity. Recommends improvements to processes and reporting capabilities. Serves as consultant to department staff in interpreting data and monitors data quality and integrity. Thoroughly analyze and understand technical/data issues and HIPAA-EDI demands and work with IT/partnerships on new system/process developments, enhancements and testing.
- Analyzes impact of process or technical tool changes on existing processes, tools, and interfaces based on knowledge of interdependencies of related functions and systems. Delivers training for end users on systems. Ensures adequacy and quality of process and procedure documentation. Performs provider recruitment and ensures HIPAA-EDI compliance.
- Participate as a subject matter expert and acceptance tester during technology investment projects and initiatives. Familiarity with HIPAA transactions 270, 271, 835, 837, 277u .
Required Skills:
- Significant (typically 3-5 years progressive) experience in business administration and information systems. Previous experience in EDI. Demonstrated knowledge in claims operations, business processes and related software applications in reporting, accounting, and claims
- Demonstrated excellence in analysis, documentation, and presentation tools required. Strong skills required in critical thinking and analysis, meeting facilitation, verbal and written communications, and interpersonal interactions (eg, partnering, conflict management, consulting, etc.). Understanding of health care business and care delivery processes preferred. Must be able to work in a Labor/Management Parnership environment.
- Healthcare/Claims/EDI industry knowledge
- Health care experience required.
- Work flow systems, and Claims adjudication knowledge preferred.
Decision Making and Problem Solving:
-Addresses volume of patient/customer needs by looking at all variables and making decisions based on urgency of specific cases, given time demands, and key priorities. Recognizes when the situation demands quick and immediate action and makes decisions quickly. Uses knowledge and expertise in order to make informed decisions.
- Participates in the analysis and definition of efficient, cost effective solutions that support client business processes and functional requirements. Participates in the evaluation of alternative operational efficiencies. Develops solutions to a variety of problems.
Soft Skills:
-Communicates and escalates issues. Provides on-going communication. Exchanges and interprets non-routine information and/or collaboration of work
-Follows established directions. Works under general supervision. Exercises some discretion within defined boundaries.
Minimum Education Requirement:
-Bachelor of Arts degree in economics, finance, health care administration, public health administration, statistics, mathematics, operations research, or related field required, or equivalent work experience in lieu of a degree.