SHR Talent is currently partnering with a healthcare company in Nashville in its search for a full-time EDI Specialist. The individual in this role will use his/her expertise and skills to support the claims department in addressing technical claims issues, analyzing, and transforming EDI x12 segments, and establishing clearinghouse connectivity as required by our clients. The EDI specialist will be the primary subject matter expert for claims processes and EDI transactions. Candidates for this position will have EDI & claims system experience within a large payer.
- Provide technical support for claims team, quickly resolve system issues, and identify and eliminate root causes.
- Coordinate connectivity with payers by working directly with payer partners, provider, and clearinghouse partners to identify, understand, and implement applicable electronic connectivity or EDI, SFTP, and/or clearinghouse configurations.
- Proactively monitor exception reporting and address issues before there is a client impact.
- Act as a subject matter expert to internal and external stakeholders on claims processes.
- Maintain current knowledge of claims connectivity technology including EDI and x12 and recommend architectural improvements.
- Experience: 3+ years claims system analysis or EDI specialist experience ideally with a large payer.
- Education: Bachelor’s degree and/or equivalent experience in computer science, information technology, or related field.
- Deep knowledge of EDI standard format (X12)
- Strong understanding of EDI business processes and technology.
- Detail oriented. Must pay exceptional attention to detail.
- Project Management: Manage multiple projects and priorities.
- Teamwork-Centered: Innovative, highly flexible, and willing to “roll-up-your-sleeves” to do what it takes in a team environment to accomplish our mission.
- Communication Skills: Must be responsive, and able to communicate efficiently and effectively.
- Experience with an EDI editing tool such as Microsoft Visual Studio Code.
- Experience with file transfer protocols and a SFTP portals.
- Proficient with Microsoft Azure, SQL, & Teams.
- Experience managing or navigating a service desk ticketing system a plus.