Payer Relations and EDI Coordinator
Job Details
TEXAS - Houston, TX
Full Time
4 Year Degree
Day
Description and Duties

Job Summary:

Benefit Recovery is looking for a Payer Relations & EDI Coordinator that will be responsible for developing, coordinating, implementing, and communicating the organization's payer relation strategies and initiatives for Healthcare Electronic Data Interchange (EDI) transactions with payers and vendors. This individual ensures that operations and processes involving payer relationships and EDI vendor management are established, properly documented, and managed. The Coordinator will also play the role of a subject matter expert or instruct staff on tasks related payers and EDI vendors including development, change requests, and enterprise integration projects. The Payer Relations & EDI Coordinator will coordinate with the Software Manager on EDI issues that arise from internal operations and software-as-a-service contracts.

 

Job Duties:

  1. Will report to the Director of Business Analysts
  2. Monitors Electronic Data Interchange (EDI) communications to and from insurance payers and other vendors for formatting or communication issues.
  3. Develops and maintains relationships with insurance payers to include helping facilitate Non-Disclosure Agreements (NDA), Data Use Agreements (DUA), and any other Memorandums of Understanding (MOU) documents
  4. Manages staff that are performing payer relation duties for multiple projects
  5. Established and manages relationships with vendors or payers to conduct HIPAA standard file transfer to and from Benefit Recovery
  6. Reviews incidents reported by user to ensure they followed correct procedural steps and determine if steps were done appropriately and documents any issues discovered.
  7. Assists with developing and familiar with company functional and technical documentation that involves any EDI transmissions to medical, dental, vision, and pharmaceutical payers.
  8. Experience working with help desk software to review and address customer or internal staff issues with EDI
  9. Conduct SQL queries to research, document, and analyze EDI issues or rejections from insurance payers
  10. Manage reporting of payer-required performance metrics and quality indicators.
  11. Continually analyze payer data to determine trends for financial accuracy.
  12. Provide education and training to staff across all silos regarding all aspects of payer trends and EDI transmissions.
  13. Manage all payer relations analysts
  14. Collaborate and coordinate with sales leadership and marketing staff.
  15. Work effectively with individuals across multiple departments throughout the organization.
  16. Familiar with all software offerings that Benefit Recovery uses in-house and licenses to clients
Qualifications

Expertise:

  1. A minimum of 3 years of experience with SQL queries or database level analysis
  2. At least 5 years of experience conducting payer relations with insurance companies
  3. Proficient understanding of HIPAA ANSI formats (837I, 837P, 837D, 835, 270, 271, 276, 277, 997, NCPDP D.0) and HIPAA EDI response messaging
  4. Ability to maintain a calm temperament with clients and fellow staff members during high intensity situations
  5. Must be able to represent the company in professional manner always as a senior member of the company
  6. Analytical expertise with documenting functional and software issues to assist with resolving EDI issues

Education:

  1. Bachelor’s Degree or higher, preferably in Management Information Systems or Management

Additional Requirements:

  1. Must agree to and pass an FBI Fingerprint background check
  2. Must have a clean financial record

 

Candidates must be able to successfully pass an initial criminal and credit clearance.

All qualified applicants will receive consideration for employment without regard to race, color, ethnicity, religion, sex, national origin, disability, veteran status, genetic data, or other legally protected status.

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