What are the responsibilities and job description for the EDI Eligibility Specialist position at Viva Health?
Electronic Data Interchange (EDI) Eligibility Specialist
Location: Birmingham, AL
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 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 EDI (Electronic Data Interchange) Eligibility Specialist will develop and maintain existing eligibility EDI programs and other PC-based programs for VIVA HEALTH. This position will assist with the maintenance and execution of recurring processes surrounding eligibility business requirements.
Key Responsibilities
- Carry out the end-to-end steps to receive and transform data to be loaded into VIVA HEALTH’S systems.
- Work closely with the Finance, Operations, and Medicare departments to support their respective business functions surrounding enrollment.
- Work with third party vendors to analyze and setup appropriate processes for eligibility and claims data feeds from VIVA HEALTH’S systems.
- Work with the Compliance/Legal departments to ensure proper documentation is in place before data feeds are setup.
REQUIRED QUALIFICATIONS:
- Bachelor’s Degree
- 1- 3 years’ experience with database technology/process management
- Demonstrated experience with successful ownership of processes
- Excellent interpersonal skills for frequent interaction with users, managers, and vendors
- Excellent verbal and written communications skills
- Excellent attention to detail and accuracy
- Knowledge of MS Access
PREFERRED QUALIFICATIONS:
- 3 – 5 years’ experience with database technology/process management
- Experience with MS SQL
- Health Plan experience
- Microsoft and/or PMI certifications
- Understanding of the relationship between health plan eligibility and premium accounting
- Knowledge of ANSI 5010 834 file formats
- Knowledge of HIPAA and ACA