EDI Administrator

PURPOSE OF THE JOB

The purpose of this job is to support the Electronic Data Interchange (EDI) program, through handling compliance for multiple jurisdictions across multiple lines of business by ensuring performance standards are met, efficiency of reporting and data quality. This role provides support to the internal Claims team, along with other analytical and project-based support functions within the department in support of business and company goals.

Essential Duties And Responsibilities

• Supports regulatory reporting, research, and compliance data management
• Collections, organizes, and analyzes claims, financial, and operational data to support reporting and business needs.
• Documents and maintains procedures on the various components of EDI reporting.
• Gains an understanding of the policies, procedures, and operations of the various reporting entities, including Medicare reporting, FROI/SROI reporting, IDC reporting to ensure compliance standards are met.
• Partners with Claims, Compliance, and business stakeholders to support operational and compliance objectives.
• Maintains department SharePoint content and support system enhancements, departmental initiatives, and special projects.
• Collaborates with internal teams, technology teams, and state agencies to manage EDI processes.
• Collaborates with internal teams, external stakeholders, and regulatory agencies to facilitate data collection, resolve data-related queries and ensure effective communication of the EDI process.
• Provides support during the implementation phase of EDI projects to assist in development of initial testing plans and participate in user acceptance testing.
• Identifies opportunities for continuous improvement
• Identifies workflow, system, and data integrity issues, recommending and supporting solutions to improve efficiency, compliance, and data quality.
• Supports with the creation and maintenance of comprehensive training materials/curriculums as needed.
• Facilitates training classes to various workers’ compensation claims audiences as needed.
• Reviews claims-related materials for accuracy and compliance, escalating concerns as needed.
• Notifies and works with appropriate Claims Team Members to resolve errors.
• Manages daily inbound and outbound data flow of EDI traffic
• Pairs with the Claims team to resolve errors and provide support on EDI processes, protocols, and system usage.
• Maintains department SharePoint content and support system enhancements, departmental initiatives, and special projects.
• Participates and supports trainings to educate Claims Team on regulatory processes
• Provides feedback on training needs and reinforces key concepts to support regulatory compliance.
• Collaborates with internal teams, technology teams, and state agencies to manage EDI processes
• Collaborates with internal teams, external stakeholders, and regulatory agencies to facilitate data collection, resolve data-related queries and ensure effective communication of the EDI process.
• Provides support during the implementation phase of EDI projects to assist in development of initial testing plans and participate in user acceptance testing.
• Identifies opportunities for continuous improvement
• Identifies workflow, system, and data integrity issues, recommending and supporting solutions to improve efficiency, compliance, and data quality.
• Supports with the creation and maintenance of comprehensive training materials/curriculums as needed.
• Facilitates training classes to various workers’ compensation claims audiences as needed.
• Reviews claims-related materials for accuracy and compliance, escalating concerns as needed.
• Notifies and works with appropriate Claims Team Members to resolve errors.
• Manages daily inbound and outbound data flow of EDI traffic
• Pairs with the Claims team to resolve errors and provide support on EDI processes, protocols, and system usage.
• Maintains department SharePoint content and support system enhancements, departmental initiatives, and special projects.
• Participates and supports trainings to educate Claims Team on regulatory processes
• Provides feedback on training needs and reinforces key concepts to support regulatory compliance.
• Collaborates with internal teams, technology teams, and state agencies to manage EDI processes
• Collaborates with internal teams, external stakeholders, and regulatory agencies to facilitate data collection, resolve data-related queries and ensure effective communication of the EDI process.
• Provides support during the implementation phase of EDI projects to assist in development of initial testing plans and participate in user acceptance testing.
• Identifies opportunities for continuous improvement
• Identifies workflow, system, and data integrity issues, recommending and supporting solutions to improve efficiency, compliance, and data quality.
• Supports with the creation and maintenance of comprehensive training materials/curriculums as needed.
• Facilitates training classes to various workers’ compensation claims audiences as needed.
• Reviews claims-related materials for accuracy and compliance, escalating concerns as needed.
• Notifies and works with appropriate Claims Team Members to resolve errors.
• Manages daily inbound and outbound data flow of EDI traffic
• Pairs with the Claims team to resolve errors and provide support on EDI processes, protocols, and system usage.
• Maintains department SharePoint content and support system enhancements, departmental initiatives, and special projects.
• Participates and supports trainings to educate Claims Team on regulatory processes
• Provides feedback on training needs and reinforces key concepts to support regulatory compliance.
• Collaborates with internal teams, technology teams, and state agencies to manage EDI processes
• Collaborates with internal teams, external stakeholders, and regulatory agencies to facilitate data collection, resolve data-related queries and ensure effective communication of the EDI process.
• Provides support during the implementation phase of EDI projects to assist in development of initial testing plans and participate in user acceptance testing.
• Identifies opportunities for continuous improvement
• Identifies workflow, system, and data integrity issues, recommending and supporting solutions to improve efficiency, compliance, and data quality.
• Supports with the creation and maintenance of comprehensive training materials/curriculums as needed.
• Facilitates training classes to various workers’ compensation claims audiences as needed.
• Reviews claims-related materials for accuracy and compliance, escalating concerns as needed.
• Notifies and works with appropriate Claims Team Members to resolve errors.
• Manages daily inbound and outbound data flow of EDI traffic
• Pairs with the Claims team to resolve errors and provide support on EDI processes, protocols, and system usage.
• Maintains department SharePoint content and support system enhancements, departmental initiatives, and special projects.
• Participates and supports trainings to educate Claims Team on regulatory processes
• Provides feedback on training needs and reinforces key concepts to support regulatory compliance.
• Collaborates with internal teams, technology teams, and state agencies to manage EDI processes
• Collaborates with internal teams, external stakeholders, and regulatory agencies to facilitate data collection, resolve data-related queries and ensure effective communication of the EDI process.
• Provides support during the implementation phase of EDI projects to assist in development of initial testing plans and participate in user acceptance testing.
• Identifies opportunities for continuous improvement
• Identifies workflow, system, and data integrity issues, recommending and supporting solutions to improve efficiency, compliance, and data quality.
• Supports with the creation and maintenance of comprehensive training materials/curriculums as needed.
• Facilitates training classes to various workers’ compensation claims audiences as needed.
• Reviews claims-related materials for accuracy and compliance, escalating concerns as needed.
• Notifies and works with appropriate Claims Team Members to resolve errors.
• Manages daily inbound and outbound data flow of EDI traffic
• Pairs with the Claims team to resolve errors and provide support on EDI processes, protocols, and system usage.
• Maintains department SharePoint content and support system enhancements, departmental initiatives, and special projects.
• Participates and supports trainings to educate Claims Team on regulatory processes
• Provides feedback on training needs and reinforces key concepts to support regulatory compliance.
• Collaborates with internal teams, technology teams, and state agencies to manage EDI processes
• Collaborates with internal teams, external stakeholders, and regulatory agencies to facilitate data collection, resolve data-related queries and ensure effective communication of the EDI process.
• Provides support during the implementation phase of EDI projects to assist in development of initial testing plans and participate in user acceptance testing.
• Identifies opportunities for continuous improvement
• Identifies workflow, system, and data integrity issues, recommending and supporting solutions to improve efficiency, compliance, and data quality.
• Supports with the creation and maintenance of comprehensive training materials/curriculums as needed.
• Facilitates training classes to various workers’ compensation claims audiences as needed.
• Reviews claims-related materials for accuracy and compliance, escalating concerns as needed.
• Notifies and works with appropriate Claims Team Members to resolve errors.
• Manages daily inbound and outbound data flow of EDI traffic
• Pairs with the Claims team to resolve errors and provide support on EDI processes, protocols, and system usage.
• Maintains department SharePoint content and support system enhancements, departmental initiatives, and special projects.
• Participates and supports trainings to educate Claims Team on regulatory processes
• Provides feedback on training needs and reinforces key concepts to support regulatory compliance.
• Collaborates with internal teams, technology teams, and state agencies to manage EDI processes
• Collaborates with internal teams, external stakeholders, and regulatory agencies to facilitate data collection, resolve data-related queries and ensure effective communication of the EDI process.
• Provides support during the implementation phase of EDI projects to assist in development of initial testing plans and participate in user acceptance testing.
• Identifies opportunities for continuous improvement
• Identifies workflow, system, and data integrity issues, recommending and supporting solutions to improve efficiency, compliance, and data quality.
• Supports with the creation and maintenance of comprehensive training materials/curriculums as needed.
• Facilitates training classes to various workers’ compensation claims audiences as needed.
• Reviews claims-related materials for accuracy and compliance, escalating concerns as needed.
• Notifies and works with appropriate Claims Team Members to resolve errors.
• Manages daily inbound and outbound data flow of EDI traffic
• Pairs with the Claims team to resolve errors and provide support on EDI processes, protocols, and system usage.
• Maintains department SharePoint content and support system enhancements, departmental initiatives, and special projects.
• Participates and supports trainings to educate Claims Team on regulatory processes
• Provides feedback on training needs and reinforces key concepts to support regulatory compliance.
• Collaborates with internal teams, technology teams, and state agencies to manage EDI processes
• Collaborates with internal teams, external stakeholders, and regulatory agencies to facilitate data collection, resolve data-related queries and ensure effective communication of the EDI process.
• Provides support during the implementation phase of EDI projects to assist in development of initial testing plans and participate in user acceptance testing.
• Identifies opportunities for continuous improvement
• Identifies workflow, system, and data integrity issues, recommending and supporting solutions to improve efficiency, compliance, and data quality.
• Supports with the creation and maintenance of comprehensive training materials/curriculums as needed.
• Facilitates training classes to various workers’ compensation claims audiences as needed.
• Reviews claims-related materials for accuracy and compliance, escalating concerns as needed.
• Notifies and works with appropriate Claims Team Members to resolve errors.