Senior EDI (Electronic Data Interchange) Claims Specialist

Location: Birmingham, AL

Work Schedule: This position will have remote work-from-home opportunities.

Why VIVA HEALTH?

VIVA HEALTH, part of the renowned University of Alabama at Birmingham (UAB) Health System, is a health maintenance organization providing quality, accessible health care. Our employees are a part of the communities they serve and proudly partner with members on their healthcare journeys.

VIVA HEALTH has been recognized by Centers for Medicare & Medicaid Services (CMS) as a high-performing health plan, receiving a 5 out of 5 Star rating - the highest rating a Medicare Advantage Plan can achieve and has been repeatedly ranked as one of the nation's Best Places to Work by Modern Healthcare.

Benefits

• Comprehensive Health, Vision, and Dental Coverage
• 401(k) Savings Plan with company match and immediate vesting
• Paid Time Off (PTO)
• 9 Paid Holidays annually plus a Floating Holiday to use as you choose
• Tuition Assistance
• Flexible Spending Accounts
• Healthcare Reimbursement Account
• Paid Parental Leave
• Community Service Time Off
• Life Insurance and Disability Coverage
• Employee Wellness Program
• Training and Development Programs to develop new skills and reach career goals
• Employee Assistance Program

See more about the benefits of working at Viva Health - https://www.vivahealth.com/careers/benefits

Job Description

The Senior EDI (Electronic Data Interchange) Claims Specialist will provide analysis and support to the EDI Claims Coordinator in processing inbound and outbound EDI claim transactions. This individual will evaluate the reply files from vendors, report errors, correct the data, and resubmit claims as necessary. This position will document required changes, assist in testing new transactions sets, and respond to internal and external EDI-related issues.

Key Responsibilities

• Provide analysis and support on complex EDI Claim Issues.
• Create and submit EDI claim transactions to various vendors and Business Partners.
• Document and evaluate reply files from Business Partners, correct the data, and resubmit files.
• Test and document new EDI processes as directed.
• Assist the EDI claims coordinator with implementing new claims related EDI transactions.

REQUIRED QUALIFICATIONS:

• Bachelor’s degree or equivalent experience
• 5 years’ experience with auditing / analyzing claims or medical data
• 3 years’ experience working with data integration
• Demonstrated aptitude for using relational databases
• Proficiency with Excel / importing data into Excel tables
• Ability to present ideas and solutions in a user-friendly language
• Self-motivated, organized, and detail oriented
• Analytical and problem solving skills with the ability to prioritize and execute tasks

PREFERRED QUALIFICATIONS:

• Experience with ANSI ASC X12 transaction sets (835, 837, 217, 272, 277, etc.)
• Experience with PowerSTEPP or similar software
• Experience with payor-side healthcare
• Experience with Extol ® Integration Software
• Knowledge of PowerSTEPP claims and eligibility systems
• Familiarity with Ingenix Claredi
• Familiarity with FTP software

Click Here to learn more about how VIVA HEALTH is building a culture where diverse voices, backgrounds, and perspectives are welcomed and celebrated!